Provider Demographics
NPI:1679699888
Name:GODSEY, JEANELLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JEANELLE
Middle Name:
Last Name:GODSEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5786 E BONIWOOD TURN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4238
Mailing Address - Country:US
Mailing Address - Phone:301-856-3760
Mailing Address - Fax:
Practice Address - Street 1:11016 FILLYS FORD XING
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-8117
Practice Address - Country:US
Practice Address - Phone:202-215-5498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05449225X00000X
DCOT010000301225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist