Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 210213 | TX |
NPI | 1003053737 |
---|---|
Provider Name | Crystal Odom |
First Address | Denver, CO 80206-4084 |
Second Address | Denver, CO 80206-4084 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2009 |
Last Update Date | 16/01/2009 |