Provider Demographics
NPI:1558783605
Name:GODINE, KAREN SUE (RN, BSN, LMT, CLT)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:SUE
Last Name:GODINE
Suffix:
Gender:F
Credentials:RN, BSN, LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6730 DONNA RAE DR
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-3704
Mailing Address - Country:US
Mailing Address - Phone:440-382-2200
Mailing Address - Fax:
Practice Address - Street 1:6730 DONNA RAE DR
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-3704
Practice Address - Country:US
Practice Address - Phone:440-382-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 166819163WG0000X, 163WM1400X
OH33. 020620 E-G225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist