Basic Information
| Provider Information | |||||||||
| NPI: | 1821137761 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOOCH | ||||||||
| FirstName: | TAMSEN | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 851 SNELL ISLE BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337043743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278230183 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 7TH AVE S | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337014820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277674257 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT9764 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.