Provider Demographics
NPI:1922124742
Name:GOODELL, EILEEN FRANCES (OT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:FRANCES
Last Name:GOODELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-1569
Mailing Address - Country:US
Mailing Address - Phone:781-593-1442
Mailing Address - Fax:
Practice Address - Street 1:96 FOREST ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-3907
Practice Address - Country:US
Practice Address - Phone:978-532-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6413225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist