Provider Demographics
NPI:1649574237
Name:GOODMAN-LAVEY, MARCIA LYNN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:LYNN
Last Name:GOODMAN-LAVEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:MARCIA
Other - Middle Name:LYNN
Other - Last Name:LAVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1846 CHAPARRO CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-6100
Mailing Address - Country:US
Mailing Address - Phone:925-260-3703
Mailing Address - Fax:924-944-4896
Practice Address - Street 1:1846 CHAPARRO CT
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-6100
Practice Address - Country:US
Practice Address - Phone:925-260-3703
Practice Address - Fax:924-944-4896
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1117225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist