Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1041 | MA |
NPI | 1013344753 |
---|---|
Provider Name | Ms. Robin Michelle Goodliss |
First Address | South Weymouth, MA 02190-1818 |
Second Address | South Weymouth, MA 02190-1818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2013 |
Last Update Date | 26/09/2013 |