Individual
MRS. STACEY P GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
926 E WAYNE ST, SOUTH BEND, IN 46617-3000
(574) 233-8812
(574) 233-8873
Mailing address
10379 EDISON RD, OSCEOLA, IN 46561-9355
(574) 674-0575
(574) 674-0575
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
32000767A
IN
Other
Enumeration date
05/09/2008
Last updated
05/09/2008
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