Provider Demographics
NPI:1861697120
Name:GOFF, KAREN RYLENE (PTA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:RYLENE
Last Name:GOFF
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2724
Mailing Address - Country:US
Mailing Address - Phone:580-221-4444
Mailing Address - Fax:800-434-1081
Practice Address - Street 1:1315 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2724
Practice Address - Country:US
Practice Address - Phone:580-221-4444
Practice Address - Fax:800-434-1081
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1218225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant