Healthcare Provider Details

I. General information

NPI: 1083550636
Provider Name (Legal Business Name): WARREN GOODIN OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11535 AVENUE 264
VISALIA CA
93277-9315
US

IV. Provider business mailing address

11992 AVENUE 272
VISALIA CA
93277-9424
US

V. Phone/Fax

Practice location:
  • Phone: 559-737-6720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number16299
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: