MEDICARE: MRS. VALERIE ANN GOODWIN OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist	31000983A	IN

General Provider Information

NPI Number	:	1023394343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VALERIE ANN GOODWIN OT

Provider Business Mailing Address
First Line	:	6922 HILLSDALE CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2040
Country	:	US
Telephone Number	:	317-621-7820
Fax Number	:	317-621-7824

Provider Business Practice Location Address
First Line	:	6922 HILLSDALE CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2040
Country	:	US
Telephone Number	:	317-621-7820
Fax Number	:	317-621-7824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	11/01/2011

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