Individual
LISA A GOODLEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2625 E SAINT LOUIS AVE, LAS VEGAS, NV 89104-4200
(170) 279-9746
Mailing address
3773 CORPOLO AVE, LAS VEGAS, NV 89141-3483
(585) 755-6845
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
009951-1
NY
Other
Enumeration date
09/18/2007
Last updated
09/18/2007
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