Provider Demographics
NPI:1871865758
Name:BEDOYA, KIM GOODWATER (MOTR/L)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:GOODWATER
Last Name:BEDOYA
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10144 ARBOR RUN DR
Mailing Address - Street 2:UNIT 109
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3566
Mailing Address - Country:US
Mailing Address - Phone:843-437-2858
Mailing Address - Fax:813-428-6050
Practice Address - Street 1:2916 HABANA WAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3566
Practice Address - Country:US
Practice Address - Phone:813-227-4347
Practice Address - Fax:813-428-6050
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12910225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist