Provider Demographics
NPI:1861451494
Name:GOODWIN, LINDA B (OTR L)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:B
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 ALLAPATCHEE DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-8447
Mailing Address - Country:US
Mailing Address - Phone:941-587-0332
Mailing Address - Fax:
Practice Address - Street 1:3500 ALLAPATCHEE DR
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-8447
Practice Address - Country:US
Practice Address - Phone:941-587-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10329225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00048945OtherRAILROAD MEDICARE NUMBER
FL33090Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FLP00048945OtherRAILROAD MEDICARE NUMBER