Individual
KAYELENE PAIGE GOODBEAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2508 SAINT JAMES RD, SPRINGFIELD, IL 62707-9736
(217) 747-5901
Mailing address
PO BOX 693, LOVINGTON, IL 61937-0693
(217) 412-9452
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057005488
IL
Other
Enumeration date
03/12/2021
Last updated
03/12/2021
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