Healthcare Provider Details

I. General information

NPI: 1639766801
Provider Name (Legal Business Name): KATHRYN GOODLETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 POPLAR BEND DR
COLUMBUS OH
43204-5024
US

IV. Provider business mailing address

3917 POPLAR BEND DR
COLUMBUS OH
43204-5024
US

V. Phone/Fax

Practice location:
  • Phone: 614-272-1352
  • Fax:
Mailing address:
  • Phone: 614-272-1352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: