Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT2716 | MS |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OTT.200503 | LA |
NPI | 1386858033 |
---|---|
Provider Name | Leigh Ann Odom |
First Address | Poplarville, MS 39470-6125 |
Second Address | Franklinton, LA 70438-1566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 20/05/2015 |