# MRS. KELLY LEE GOODMAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1528272531
- **Gender:** F
- **Credential:** OTR

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | 3954-026 | WI | Yes |

## Other

- **Enumeration date:** 05/09/2007
- **Last updated:** 03/17/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 40868400 | — | WI |