Organization
UPSTATE PEDIATRIC THERAPY CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACIE MARIE GOODWIN OTR/L (OWNER)
(208) 989-9487
Entity
Organization
Contact information
Practice address
1460 CONEROSS POINT DR, SENECA, SC 29678-5908
(208) 989-9487
Mailing address
1460 CONEROSS POINT DR, SENECA, SC 29678-5908
(208) 989-9487
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
02/07/2023
Last updated
02/07/2023
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