Individual
MRS. MARIE THERESA GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2600 MENDON RD, CUMBERLAND, RI 02864-3726
(401) 658-1600
Mailing address
341 CHESTNUT HILL RD, WAKEFIELD, RI 02879-7648
(401) 792-9072
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA00031
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTA00031
RHODE ISLAND LICENSE
RI
Enumeration date
03/23/2007
Last updated
07/08/2007
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