Provider Demographics
NPI:1518113083
Name:GOODMAN, NELL KATHLEEN
Entity Type:Individual
Prefix:MRS
First Name:NELL
Middle Name:KATHLEEN
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5334 VANTAGE AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2616
Mailing Address - Country:US
Mailing Address - Phone:818-763-1097
Mailing Address - Fax:
Practice Address - Street 1:5334 VANTAGE AVE APT 6
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2616
Practice Address - Country:US
Practice Address - Phone:818-763-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner