Healthcare Provider Details

I. General information

NPI: 1164209953
Provider Name (Legal Business Name): AMANDA GODFREY OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N NELLIS BLVD STE 130
LAS VEGAS NV
89110-5387
US

IV. Provider business mailing address

3753 TIFFIN CT
LAS VEGAS NV
89129-6846
US

V. Phone/Fax

Practice location:
  • Phone: 702-452-4563
  • Fax:
Mailing address:
  • Phone: 760-710-7423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-3326
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: