Provider Demographics
NPI:1912409749
Name:GOODMAN, SAMANTHA G (OTR)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:G
Last Name:GOODMAN
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 1:3287 S 1000 W
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:IN
Mailing Address - Zip Code:47443-7003
Mailing Address - Country:US
Mailing Address - Phone:812-381-4040
Mailing Address - Fax:
Practice Address - Street 1:661 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-5926
Practice Address - Country:US
Practice Address - Phone:559-784-8371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist