Provider Demographics
NPI:1376203984
Name:GODEC, JAMIE K
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:K
Last Name:GODEC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 E SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1413
Mailing Address - Country:US
Mailing Address - Phone:216-210-8878
Mailing Address - Fax:
Practice Address - Street 1:7325 E PRINCESS BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5991
Practice Address - Country:US
Practice Address - Phone:216-210-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist