Provider Demographics
NPI:1699747428
Name:GODEK, MICHELLE MARIE (ATC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:GODEK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:10010 ALDERMAN RD
Mailing Address - Street 2:
Mailing Address - City:MILLFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45761-9639
Mailing Address - Country:US
Mailing Address - Phone:740-591-3538
Mailing Address - Fax:
Practice Address - Street 1:OHIO UNIVERSITY
Practice Address - Street 2:PEDEN TOWER RM 118
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-593-1195
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0015962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer