Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XH1200X | Occupational Therapist - Hand | 1659 | CA |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1659 | CA |
N | 225XP0200X | Occupational Therapist - Pediatrics | 1659 | CA |
NPI | 1104374198 |
---|---|
Provider Name | Mary Ann O'dell |
First Address | Sacramento, CA 95817-2215 |
Second Address | Sacramento, CA 95817-2215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2016 |
Last Update Date | 19/09/2016 |