Provider Demographics
NPI:1023210333
Name:GOODELL, REBECCA SKELTON (PT)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SKELTON
Last Name:GOODELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7630 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-7785
Mailing Address - Country:US
Mailing Address - Phone:360-856-2539
Mailing Address - Fax:
Practice Address - Street 1:780 COOK RD
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-4341
Practice Address - Country:US
Practice Address - Phone:360-855-3872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002555174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist