Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 46TR00203900 | NJ |
N | 225XH1200X | Occupational Therapist - Hand | 9711000541 | NJ |
NPI | 1255452645 |
---|---|
Provider Name | Minette C Godbole |
First Address | Old Bridge, NJ 08857-2882 |
Second Address | Freehold, NJ 07728-8305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2010 |