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MISS LESLIE KENDLE GOODRUM

>> Occupational Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1982748570

Individual Registrant:
MISS LESLIE KENDLE GOODRUM 
Gender: F
Sole Proprietor

Location and contact information for practice:
38201 W INDIAN SCHOOL RD  TONOPAH, AZ 85354-7301 US
Tel: 623-386-5688  Fax: --

Contact information for business:
11601 S MAZE CT  PHOENIX, AZ 85044-2319 US
Tel: 480-753-6360  Fax: --

Registration Information:
NPI: 1982748570
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Occupational Therapist
AZ0753

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
225XP0200XAZ05




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