Basic Information
| Provider Information | |||||||||
| NPI: | 1790404648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODIN | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 116 W SUGAR ST | ||||||||
| Address2: | |||||||||
| City: | CRIDERSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458062344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5677120823 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2075 N EASTOWN RD | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458072067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193312442 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2022 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OTA.04827 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.