Sheree Goodale, COTA/L

Individual provider Active NPI Occupational Therapy Assistant · Concord, VA

NPI 1811239809 · NPPES record last updated Mar 18, 2013

Key facts

NPI
1811239809
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
0131000424 (VA)
Practice address
1475 Lyle Thomas Rd
Concord, VA 24538-3261
Phone
(434) 993-3963
Fax
(434) 993-3556
NPI assigned
Mar 18, 2013
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
0131000424VAMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 0131000424 VA Yes

Addresses

Primary practice location

1475 Lyle Thomas Rd
Concord, VA 24538-3261

Mailing address

PO Box 106
Concord, VA 24538-0106
Phone (434) 993-3963

Other providers in Concord, VA

All providers in Concord, VA · Occupational Therapy Assistant in Virginia

Sources for this page

Verify at the official NPI Registry.