Provider Demographics
NPI:1578066189
Name:BOADO, GODFREY (LOTA)
Entity Type:Individual
Prefix:
First Name:GODFREY
Middle Name:
Last Name:BOADO
Suffix:
Gender:M
Credentials:LOTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25918 CRESTFORD PARK LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2038
Mailing Address - Country:US
Mailing Address - Phone:832-620-5893
Mailing Address - Fax:
Practice Address - Street 1:25918 CRESTFORD PARK LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2038
Practice Address - Country:US
Practice Address - Phone:832-620-5893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207853224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant