Provider Demographics
NPI:1376023366
Name:GODFREDSEN, DARLENE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:
Last Name:GODFREDSEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 BAKER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2727
Mailing Address - Country:US
Mailing Address - Phone:903-815-2574
Mailing Address - Fax:
Practice Address - Street 1:1661 BAKER RIDGE RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2727
Practice Address - Country:US
Practice Address - Phone:903-815-2574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-19
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109309225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist