Individual
MR. RUSTY ALLEN GODFREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
63 BLACKSTOCK RD, INMAN, SC 29349-1835
(864) 472-9055
Mailing address
63 BLACKSTOCK RD, INMAN, SC 29349-1835
(864) 472-9055
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2664
SC
Other
Enumeration date
07/16/2007
Last updated
07/16/2007
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