Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 12589 | TN |
Y | 213ES0000X | Sports Medicine | 12589 | TN |
NPI | 1124598677 |
---|---|
Provider Name | Ms. Skyler Shanelle O'dell |
First Address | Knoxville, TN 37923-4603 |
Second Address | Knoxville, TN 37923-4603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2018 |
Last Update Date | 27/11/2018 |