Healthcare Provider Details

I. General information

NPI: 1669095980
Provider Name (Legal Business Name): ANGELICA ARACELI GOODRICH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 06/05/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W CLAY RD # 1177
VERSAILLES MO
65084-1177
US

IV. Provider business mailing address

44 HIGHWAY Z
ELDON MO
65026-4817
US

V. Phone/Fax

Practice location:
  • Phone: 573-378-5411
  • Fax:
Mailing address:
  • Phone: 785-893-3305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2020010011
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: