Individual
MELISSA JANE GOODWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
414 FOREST AVE, MEMPHIS, MO 63555-1644
(660) 342-4712
Mailing address
414 FOREST AVE, MEMPHIS, MO 63555-1644
(660) 342-4712
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
072679
IA
Other
Enumeration date
07/15/2019
Last updated
07/15/2019
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