Individual
STEPHANIE GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
114 W MAIN ST, CUERO, TX 77954-3736
(210) 215-3190
Mailing address
8064 US HIGHWAY 183 S, CUERO, TX 77954-5518
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14226873
—
TX
Enumeration date
03/14/2018
Last updated
04/13/2022
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