Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 20215273 | VT |
NPI | 1689828253 |
---|---|
Provider Name | David R Goodspeed |
First Address | Rutland, VT 05701-2760 |
Second Address | Rutland, VT 05701-2760 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2008 |
Last Update Date | 18/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1006112 | (05) | VT |
1016140001 | NGS SUPPLIER (01) | VT |