Healthcare Provider Details

I. General information

NPI: 1285599944
Provider Name (Legal Business Name): LACEY DAWN GODFREY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 MARKETING PL STE B
GROVEPORT OH
43125-9308
US

IV. Provider business mailing address

4038 BOWEN POND DR APT 306
CANAL WINCHESTER OH
43110-3546
US

V. Phone/Fax

Practice location:
  • Phone: 614-492-2520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2024021254
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT013283
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: