Individual
JOHN EDWARD GOODFELLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTD, OTR/L
Contact information
Practice address
2505 W SHAW AVE BLDG A, FRESNO, CA 93711-3334
(559) 228-9100
(559) 432-8055
Mailing address
2505 W SHAW AVE BLDG A, FRESNO, CA 93711-3334
(559) 228-9100
(559) 432-8055
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2598
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2598
BOARD OF OCCUPATIONAL THERAPY
CA
Enumeration date
09/18/2018
Last updated
09/18/2018
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