Provider Demographics
NPI:1396239091
Name:GOODMAN, BERRIT HARRIET ESTELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:BERRIT
Middle Name:HARRIET ESTELLE
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 1:604 N 16TH ST RM 215
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2117
Mailing Address - Country:US
Mailing Address - Phone:414-288-1400
Mailing Address - Fax:414-288-6079
Practice Address - Street 1:604 N 16TH ST RM 104
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2117
Practice Address - Country:US
Practice Address - Phone:414-288-6122
Practice Address - Fax:414-288-6079
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60858224225X00000X
WI8111-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist