Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 31000983A | IN |
NPI | 1023394343 |
---|---|
Provider Name | Mrs. Valerie Ann Goodwin |
First Address | Indianapolis, IN 46250-2040 |
Second Address | Indianapolis, IN 46250-2040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2011 |
Last Update Date | 01/11/2011 |