Provider Demographics
NPI:1568894764
Name:GODFREY, FELICE CARMEL (COTA)
Entity Type:Individual
Prefix:MRS
First Name:FELICE
Middle Name:CARMEL
Last Name:GODFREY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-0116
Mailing Address - Country:US
Mailing Address - Phone:203-405-3568
Mailing Address - Fax:
Practice Address - Street 1:33 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7963
Practice Address - Country:US
Practice Address - Phone:203-797-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1402224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant