MEDICARE: DORIAN GOODMAN MS, OTR/L

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	225XP0200X	Pediatric Occupational Therapist	OT26687	FL

General Provider Information

NPI Number	:	1295301570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORIAN GOODMAN MS, OTR/L

Provider Business Mailing Address
First Line	:	3405 GRAY CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2927
Country	:	US
Telephone Number	:	813-842-6071
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 W SWANN AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-2477
Country	:	US
Telephone Number	:	813-251-1618
Fax Number	:

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

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	03/03/2026

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