Healthcare Provider Details

I. General information

NPI: 1861814923
Provider Name (Legal Business Name): ESTHER GOODMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 YORK RD STE 300
LUTHERVILLE MD
21093-6019
US

IV. Provider business mailing address

1300 YORK RD STE 300
LUTHERVILLE MD
21093-6019
US

V. Phone/Fax

Practice location:
  • Phone: 410-828-4629
  • Fax:
Mailing address:
  • Phone: 410-828-4629
  • Fax: 410-828-4783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number08378
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: