Individual
STACIE MARIE GOODWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
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
225XP0200X
Pediatric Occupational Therapist
Primary
5551
SC
Other
Enumeration date
02/07/2023
Last updated
02/07/2023
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