MEDICARE: SHANNON GODFREY MOTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1487226445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON GODFREY MOTR/L

Provider Business Mailing Address
First Line	:	PO BOX 851
Second Line	:
City	:	SAPULPA
State	:	OK
Zip	:	74067-0851
Country	:	US
Telephone Number	:	918-607-1477
Fax Number	:

Provider Business Practice Location Address
First Line	:	9220 S PENNSYLVANIA AVE STE C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6909
Country	:	US
Telephone Number	:	405-455-5582
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2021
Last Update Date	:	07/10/2025

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