Provider Demographics
NPI:1811109473
Name:GOODWIN, ERIKA ANNE (PHD, ATC, LAT, EMT)
Entity type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:ANNE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:PHD, ATC, LAT, EMT
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:ANNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, ATC,LAT,EMT
Mailing Address - Street 1:336 PORT WILLIAM RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-9509
Mailing Address - Country:US
Mailing Address - Phone:937-486-3504
Mailing Address - Fax:
Practice Address - Street 1:336 PORT WILLIAM RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-9509
Practice Address - Country:US
Practice Address - Phone:937-486-3504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-10062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer