Provider Demographics
NPI:1053939819
Name:GOODE, ERIN OLIVIA (OT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:OLIVIA
Last Name:GOODE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:MS
Mailing Address - Zip Code:38852-8605
Mailing Address - Country:US
Mailing Address - Phone:662-424-9500
Mailing Address - Fax:
Practice Address - Street 1:960 COMMONWEALTH BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-9762
Practice Address - Country:US
Practice Address - Phone:662-260-3789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT-3790225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist