Basic Information
| Provider Information | |||||||||
| NPI: | 1427566488 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GOB | ||||||||
| FirstName: | JOANNA | ||||||||
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| Credential: | MS, OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21610 ORRICK AVE UNIT 3 | ||||||||
| Address2: | |||||||||
| City: | CARSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907452040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624727470 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17075 BUSHARD ST | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927082836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149649277 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2018 | ||||||||
| LastUpdateDate: | 09/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 17970 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.