Provider Demographics
NPI:1699975219
Name:GODDARD, TERRY LYNN (OTR)
Entity type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:LYNN
Last Name:GODDARD
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 1:9475 SHYRE CIR
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-8625
Mailing Address - Country:US
Mailing Address - Phone:810-653-9286
Mailing Address - Fax:810-658-0564
Practice Address - Street 1:9475 SHYRE CIR
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-8625
Practice Address - Country:US
Practice Address - Phone:810-653-9286
Practice Address - Fax:810-658-0564
Is Sole Proprietor?:No
Enumeration Date:2007-07-21
Last Update Date:2007-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003077225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist