NPI 1568639490

Stacey P Goodman, COTA

Practitioner Specialist South Bend, IN

Practice location

Address: 926 E Wayne St, South Bend, IN 46617-3000
Phone: (574) 233-8812
Fax: (574) 233-8873
Mailing address: 10379 Edison Rd, Osceola, IN 46561-9355

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence 32000767A (IN)

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Registry record

NPI: 1568639490
Entity type: Individual
Sex (as registered): Female
NPI issued: 9 May 2008
Record last updated: 9 May 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.