Provider Demographics
NPI:1760265771
Name:GODFREY, RACHELLE ROSE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:ROSE
Last Name:GODFREY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:ROSE
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1515 BROOKSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-8210
Mailing Address - Country:US
Mailing Address - Phone:440-226-8869
Mailing Address - Fax:
Practice Address - Street 1:1515 BROOKSTONE BLVD
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-8210
Practice Address - Country:US
Practice Address - Phone:440-226-8869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA003491224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant