=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376782888
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH BETH GOLDMAN PHD, OTR/L, CHT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2009
-----------------------------------------------------
Last Update Date | 02/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42 KANSAS ST BLDG 42 US ARMY RESEARCH INSTITUTE OF ENVIRONMENTAL MEDICINE
-----------------------------------------------------
City | NATICK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01760-2642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-233-5454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42 KANSAS ST BLDG 42 US ARMY RESEARCH INSTITUTE OF ENVIRONMENTAL MEDICINE
-----------------------------------------------------
City | NATICK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01760-2642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-233-5454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171000000X
-----------------------------------------------------
Taxonomy Name | Military Health Care Provider
-----------------------------------------------------
License Number | OT8635
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------