Provider Demographics
NPI:1083825178
Name:GOODHART, DEBORAH E (COTA)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:E
Last Name:GOODHART
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BERWICK ST
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-1607
Mailing Address - Country:US
Mailing Address - Phone:908-707-0419
Mailing Address - Fax:
Practice Address - Street 1:5 BERWICK ST
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1607
Practice Address - Country:US
Practice Address - Phone:908-707-0419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09038800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist