Organization
ALYSSON GOODWIN, OTR/L
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALYSSON GOODWIN OTR/L (OWNER)
(318) 792-1696
Entity
Organization
Contact information
Practice address
1090 JOHNNIE DODDS BLVD STE C, MOUNT PLEASANT, SC 29464-6108
(843) 284-6278
Mailing address
29 RACE ST, CHARLESTON, SC 29403-4634
(318) 792-1696
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
W53062SC1
—
SC
Enumeration date
07/17/2019
Last updated
07/17/2019
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