Individual
MRS. KELLY LEE GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
21211 STATE ROAD 57, KIEL, WI 53042-2145
(920) 740-2747
Mailing address
21211 STATE ROAD 57, KIEL, WI 53042-2145
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3954-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40868400
—
WI
Enumeration date
05/09/2007
Last updated
03/17/2015
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