Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 114166 | TX |
NPI | 1275876161 |
---|---|
Provider Name | Christina Marie O'dell |
First Address | Burleson, TX 76028-6795 |
Second Address | Fort Worth, TX 76132-6108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2013 |
Last Update Date | 29/03/2013 |