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General NPI Number Information
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NPI Number | 1871861971
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Entity Type | Individual
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Provider Name | LISA GOEDDEL OTR
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Gender | Female
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 31 FOGGINTOWN RD
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City | BREWSTER
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State | NY
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Zip | 10509-2712
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Country | US
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Telephone | 845-279-2087
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Fax |
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Provider Business Mailing Address
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Address Line | 618 CONIFER LN
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City | KINGSTON
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State | NY
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Zip | 12401-1806
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Country | US
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Telephone | 845-331-7114
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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 | 004297
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License Number State | NY
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