Individual
MIKELLE COLEMAN GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
700 FOOTHILL BLVD, SALT LAKE CITY, UT 84113-1104
(801) 584-1900
Mailing address
206 N 2100 W, SALT LAKE CITY, UT 84116-4740
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
8106618-4202
UT
Other
Enumeration date
03/06/2018
Last updated
03/06/2018
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