Provider Demographics
NPI:1841760543
Name:GODSIL, JAIRRAH LA NEACE (OTR/L, OTD, MOT)
Entity Type:Individual
Prefix:DR
First Name:JAIRRAH
Middle Name:LA NEACE
Last Name:GODSIL
Suffix:
Gender:F
Credentials:OTR/L, OTD, MOT
Other - Prefix:MS
Other - First Name:JAIRRAH
Other - Middle Name:LA NEACE
Other - Last Name:MANSFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, MOT
Mailing Address - Street 1:ATTN: PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - Street 2:2401 GILLHAM ROAD
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-701-5200
Mailing Address - Fax:816-302-9939
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3380
Practice Address - Fax:816-302-9979
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-03386225X00000X
CAOT17857225X00000X
MO2018004819225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist