Provider Demographics
NPI:1083835482
Name:GOODRICH, KRISTEN MORGAN (OTR)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MORGAN
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EPPING
Mailing Address - State:NH
Mailing Address - Zip Code:03042-2466
Mailing Address - Country:US
Mailing Address - Phone:978-799-2580
Mailing Address - Fax:888-965-8085
Practice Address - Street 1:131 MAIN ST
Practice Address - Street 2:
Practice Address - City:EPPING
Practice Address - State:NH
Practice Address - Zip Code:03042-2466
Practice Address - Country:US
Practice Address - Phone:978-799-2580
Practice Address - Fax:888-965-8085
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8636225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2374OtherLICENSE - STATE OF NH