Stacie Marie Goodwin, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

5551 Issued in SC

Practice address

1460 Coneross Point Dr
Seneca, SC 29678-5908

Phone

(208) 989-9487

NPI assigned

Feb 7, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Upstate Pediatric Therapy Co

  • Occupational Therapist
  • Seneca, SC
  • NPI 1053018325
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1427755784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 CONEROSS POINT DR",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "296785908",
            "telephone_number": "208-989-9487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 CONEROSS POINT DR",
            "city": "SENECA",
            "state": "SC",
            "postal_code": "296785908",
            "telephone_number": "208-989-9487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODWIN",
        "first_name": "STACIE",
        "middle_name": "MARIE",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "SC",
            "license": "5551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lissa Disparano Gilreath, DMD
• Samantha Lauren Giroux, PHARMD
• Jessica Taylor Glymph, FNP
• Golden Corner Internal Medicine PA
• Ronald D Gooden, AU.D
• Cari McCall Gosnell, M.ED, LCAS, LPC
• Kim Gosnell, NP
• Grace Counseling Center J. Ray Addison PH.D. PRT Et Al
• Grace Dentistry, LLC
• Brandi Graham

• Pediatric Occupational Therapist in Seneca, SC
• Providers in Seneca, SC by specialty
• Pediatric Occupational Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.