Healthcare Provider Details

I. General information

NPI: 1346204237
Provider Name (Legal Business Name): LAUREN QUIGLEY ODELL MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 HARTFORD TPKE
VERNON CT
06066-4841
US

IV. Provider business mailing address

428 HARTFORD TPKE
VERNON CT
06066-4841
US

V. Phone/Fax

Practice location:
  • Phone: 860-871-2508
  • Fax: 860-871-1478
Mailing address:
  • Phone: 860-871-2508
  • Fax: 860-871-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7724
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: