Provider Demographics
NPI:1316421969
Name:GOODIN, RUTH ANNA (COTA)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANNA
Last Name:GOODIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 JERRY ANN DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78542-6773
Mailing Address - Country:US
Mailing Address - Phone:956-457-8369
Mailing Address - Fax:
Practice Address - Street 1:912 E NOLANA LOOP
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5838
Practice Address - Country:US
Practice Address - Phone:956-299-3906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212613224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant