Provider Demographics
NPI:1871655225
Name:GOODFELLOW OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:GOODFELLOW OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOODFELLOW
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:559-228-9100
Mailing Address - Street 1:2505 W SHAW AVE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3334
Mailing Address - Country:US
Mailing Address - Phone:559-228-9100
Mailing Address - Fax:559-228-9200
Practice Address - Street 1:2505 W SHAW AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3334
Practice Address - Country:US
Practice Address - Phone:559-228-9100
Practice Address - Fax:559-228-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2598225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty