Provider Demographics
NPI:1447443791
Name:JONES-GOODWIN, RHODA FELICIA (OTR)
Entity type:Individual
Prefix:MRS
First Name:RHODA
Middle Name:FELICIA
Last Name:JONES-GOODWIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:RHODA
Other - Middle Name:FELICIA
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:3567 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206-3049
Mailing Address - Country:US
Mailing Address - Phone:414-372-8115
Mailing Address - Fax:414-372-1411
Practice Address - Street 1:316 N MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-5885
Practice Address - Country:US
Practice Address - Phone:888-389-9030
Practice Address - Fax:888-389-9031
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1751-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40699000Medicaid