Most Relevant Information
Provider Data
| NPI Number: | 1003421710 |
| Provider Name: | GRACELYN J. GOODWIN COTA/L |
| Entity Type: | Individual |
| Taxonomy Code: | 224Z00000X |
| Specialty: | Occupational Therapy Assistant |
| License Number: | OTA17498 |
Most Important Dates
| Enumeration Date: | 09/09/2020 |
| Last Updated: | 09/09/2020 |
Provider Practice Location
2711 CAPITAL MEDICAL BLVD
TALLAHASSEE
FL
323084497
Practice Location Phone/Fax
| Phone: | 8502101172 |
| Fax: |
Provider Mailing Location
7820 HIGHWAY 90
SNEADS
FL
324602232
Provider Mailing Phone/Fax
| Phone: | 8505578686 |
| Fax: |