Individual
RUSSELL BRYANT GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1452 EDGEWOOD LN, MILFORD, MI 48381-1226
(248) 787-4570
Mailing address
1452 EDGEWOOD LN, MILFORD, MI 48381-1226
(248) 787-4570
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202008280
MI
Other
Enumeration date
02/22/2024
Last updated
02/22/2024
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