Healthcare Provider Details

I. General information

NPI: 1427052760
Provider Name (Legal Business Name): LAURA J GODFREY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5312
US

IV. Provider business mailing address

575 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5312
US

V. Phone/Fax

Practice location:
  • Phone: 605-219-2667
  • Fax: 605-217-2900
Mailing address:
  • Phone: 605-219-2667
  • Fax: 605-217-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number00475
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0361
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: