Active NPI
Michaela Goodloe
- Recreational Therapist Assistant
- Brigham City, UT
National Provider Identifier
1083266993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreational Therapist Assistant
- License
- 13482080-4003
- Practice address
- 1040 S 500 W
Brigham City, UT 84302-5599 - Phone
- (801) 864-8164
- NPI assigned
- Jul 10, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Recreational Therapist Assistant | 226000000X | 13482080-4003 | UT | Primary |
| Music Therapist | 225A00000X | 13482080-4010 | UT |
Addresses
Primary practice location
1040 S 500 W
Brigham City, UT 84302-5599
Mailing address
52 E Spring Creek Pkwy
Providence, UT 84332-9828
Phone (801) 864-8164
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13482080-4010 | UT | MD | Music Therapist |
| 13482080-4003 | UT | MD | Recreational Therapist Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712620800000",
"number": "1083266993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "52 E SPRING CREEK PKWY",
"city": "PROVIDENCE",
"state": "UT",
"postal_code": "843329828",
"telephone_number": "801-864-8164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1040 S 500 W",
"city": "BRIGHAM CITY",
"state": "UT",
"postal_code": "843025599",
"telephone_number": "801-864-8164"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODLOE",
"first_name": "MICHAELA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-10",
"last_updated": "2024-04-09",
"certification_date": "2024-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "226000000X",
"taxonomy_group": "",
"desc": "Recreational Therapist Assistant",
"state": "UT",
"license": "13482080-4003",
"primary": true
},
{
"code": "225A00000X",
"taxonomy_group": "",
"desc": "Music Therapist",
"state": "UT",
"license": "13482080-4010",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brigham City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.