Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 101599 | MN |
NPI | 1144466897 |
---|---|
Provider Name | Debra Louise Odell |
First Address | Monticello, MN 55362-8467 |
Second Address | Minneapolis, MN 55407-3723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2008 |
Last Update Date | 31/12/2008 |