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General NPI Number Information
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NPI Number | 1366554099
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Entity Type | Individual
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Provider Name | KELLY B. GODFREY OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 5110 S YALE AVE STE 103
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City | TULSA
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State | OK
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Zip | 74135-7401
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Country | US
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Telephone | 918-492-2386
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Fax | 918-645-8686
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Provider Business Mailing Address
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Address Line | 5110 S YALE AVE STE 103
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City | TULSA
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State | OK
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Zip | 74135-7401
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Country | US
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Telephone | 918-492-2386
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Fax | 918-645-8686
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 1464
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License Number State | OK
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