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General NPI Number Information
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NPI Number | 1912409749
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Entity Type | Individual
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Provider Name | SAMANTHA G GOODMAN OTR
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Gender | Female
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 661 W POPLAR AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-5926
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Country | US
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Telephone | 559-784-8371
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Fax |
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Provider Business Mailing Address
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Address Line | 3287 S 1000 W
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City | LYONS
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State | IN
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Zip | 47443-7003
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Country | US
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Telephone | 812-381-4040
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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 |
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License Number State |
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