Provider Demographics
NPI:1013230747
Name:GODDARD, JUDITH AUMA (MOT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:AUMA
Last Name:GODDARD
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:AUMA
Other - Last Name:BONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5195 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-6406
Mailing Address - Country:US
Mailing Address - Phone:417-684-7415
Mailing Address - Fax:
Practice Address - Street 1:5195 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-6406
Practice Address - Country:US
Practice Address - Phone:417-684-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009026759225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist