Individual
MICHAEL K GODDARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
348 NORTHRIDGE DR APT 104, LEWISBURG, WV 24901-9053
(304) 520-4379
Mailing address
261 11TH ST, RAINELLE, WV 25962-1255
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
06/24/2020
Last updated
06/24/2020
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