Healthcare Provider Details

I. General information

NPI: 1558835405
Provider Name (Legal Business Name): CORINA FELICIA GODOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8961 DANIELS CENTER DR STE 401
FORT MYERS FL
33912-0314
US

IV. Provider business mailing address

8961 DANIELS CENTER DR STE 401
FORT MYERS FL
33912-0314
US

V. Phone/Fax

Practice location:
  • Phone: 239-433-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number25369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: