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General NPI Number Information
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NPI Number | 1205151164
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Entity Type | Individual
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Provider Name | JANINA GOODMAN OT
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Gender | Female
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Dates
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Enumeration Date | 04/05/2010
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 11675 E THUNDERBIRD TRL
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City | TUCSON
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State | AZ
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Zip | 85749-9502
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Country | US
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Telephone | 708-259-3017
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Fax |
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Provider Business Mailing Address
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Address Line | 21630 N 19TH AVE STE B3
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City | PHOENIX
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State | AZ
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Zip | 85027-2717
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Country | US
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Telephone | 602-726-2300
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Fax |
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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 | 056008996
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 4775
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License Number State | AZ
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