Provider Demographics
NPI:1578833455
Name:GOERTZ, GARRISON RONALD (MOT, OTR/L)
Entity type:Individual
Prefix:MR
First Name:GARRISON
Middle Name:RONALD
Last Name:GOERTZ
Suffix:
Gender:M
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25145 STARR ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2961
Mailing Address - Country:US
Mailing Address - Phone:559-859-4531
Mailing Address - Fax:
Practice Address - Street 1:25145 STARR ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2961
Practice Address - Country:US
Practice Address - Phone:559-859-4531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12413225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist