Provider Demographics
NPI:1760788327
Name:GOODSON, TARA (OTR)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:GOODSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 140TH AVE NE
Mailing Address - Street 2:SUITE B105
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1879
Mailing Address - Country:US
Mailing Address - Phone:425-644-6328
Mailing Address - Fax:
Practice Address - Street 1:2445 140TH AVE NE
Practice Address - Street 2:SUITE B105
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-1879
Practice Address - Country:US
Practice Address - Phone:425-644-6328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 00000427225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist