Provider Demographics
NPI:1215271879
Name:GOODMAN, CYNTHIA SUE (OTR/L)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SUE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1794 SW BATTAGLIA AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-5733
Mailing Address - Country:US
Mailing Address - Phone:503-667-8067
Mailing Address - Fax:
Practice Address - Street 1:1794 SW BATTAGLIA AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-5733
Practice Address - Country:US
Practice Address - Phone:503-667-8067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2138225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist