Individual
RUSTEN RAY GODWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
4302 ROSS AVE APT 3041, DALLAS, TX 75204-5114
(501) 339-6193
Mailing address
4302 ROSS AVE APT 3041, DALLAS, TX 75204-5114
(501) 339-6193
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
216247
TX
Other
Enumeration date
11/15/2021
Last updated
11/15/2021
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