Individual
MISS LESLIE KENDLE GOODRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
38201 W INDIAN SCHOOL RD, TONOPAH, AZ 85354-7301
(623) 386-5688
Mailing address
11601 S MAZE CT, PHOENIX, AZ 85044-2319
(480) 753-6360
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0753
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
225XP0200X
—
AZ
Enumeration date
02/16/2007
Last updated
07/09/2007
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