Healthcare Provider Details

I. General information

NPI: 1235312166
Provider Name (Legal Business Name): MS. JACQUELINE ANN GODWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HARVEY RD UNIT 6
BEDFORD NH
03110-6818
US

IV. Provider business mailing address

30 HARVEY RD UNIT 6
BEDFORD NH
03110-6818
US

V. Phone/Fax

Practice location:
  • Phone: 603-296-5241
  • Fax: 603-606-2443
Mailing address:
  • Phone: 781-492-9696
  • Fax: 603-606-2443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4122
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: