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General NPI Number Information
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NPI Number | 1194272237
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Entity Type | Individual
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Provider Name | SUSAN GOEDEKEN O.T.
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Gender | Female
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 495 WEST ST UNIT 1D
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City | AMHERST
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State | MA
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Zip | 01002-3379
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Country | US
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Telephone | 413-450-0082
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Fax | 413-450-0440
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Provider Business Mailing Address
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Address Line | 495 WEST ST UNIT 1D
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City | AMHERST
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State | MA
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Zip | 01002-3379
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Country | US
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Telephone | 413-450-0082
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Fax | 413-450-0440
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 11928
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License Number State | MA
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