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NPI Code Detail

MEDICARE: MICHELLE S GODFREY OTRL, CHT

MEDICARE: MICHELLE S GODFREY OTRL, CHT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist437SC
2225XH1200XHand Occupational Therapist437SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Q357577567OTHERSCMEDICARE PROVIDER TRANSACTION ACCESS NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
21396737979OTHERSCNPI

General Provider Information

NPI Number : 1396737979
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE S GODFREY OTRL, CHT
Provider Business Mailing Address
First Line : 8811 WARREN H ABERNATHY HWY
Second Line :
City : SPARTANBURG
State : SC
Zip : 29301-1228
Country : US
Telephone Number : 864-574-7282
Fax Number : 864-574-7664
Provider Business Practice Location Address
First Line : 8811 WARREN H ABERNATHY HWY
Second Line :
City : SPARTANBURG
State : SC
Zip : 29301-1550
Country : US
Telephone Number : 864-574-7282
Fax Number : 864-574-7664
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 06/25/2013

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