Individual
MYKA GOODRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1101 KELLER PKWY, KELLER, TX 76248-3614
(817) 562-3111
(817) 562-3114
Mailing address
1101 KELLER PKWY, KELLER, TX 76248-3614
(817) 562-3111
(817) 562-3114
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
119534
TX
Other
Enumeration date
11/07/2018
Last updated
08/19/2021
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