Provider Demographics
NPI:1306254065
Name:KIM GOODING OCCUPATIONAL THERAPY PLLC
Entity type:Organization
Organization Name:KIM GOODING OCCUPATIONAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODING
Authorized Official - Suffix:
Authorized Official - Credentials:MS,OTR/L,CLT
Authorized Official - Phone:207-749-2234
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:27 AMBER ROAD
Mailing Address - City:RANGELEY
Mailing Address - State:ME
Mailing Address - Zip Code:04970-0456
Mailing Address - Country:US
Mailing Address - Phone:207-864-9220
Mailing Address - Fax:207-512-1031
Practice Address - Street 1:25 DALLAS HILL ROAD
Practice Address - Street 2:
Practice Address - City:RANGELEY
Practice Address - State:ME
Practice Address - Zip Code:04970
Practice Address - Country:US
Practice Address - Phone:207-864-9220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME1636225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1932377967OtherNPI