Healthcare Provider Details

I. General information

NPI: 1326220096
Provider Name (Legal Business Name): CYNTHIA LOUISE ODELL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 SW G ST.
GRANTS PASS OR
97526
US

IV. Provider business mailing address

315 WEST EVANS CREEK RD # 71
ROGUE RIVER OR
97537
US

V. Phone/Fax

Practice location:
  • Phone: 541-660-8787
  • Fax: 541-479-4643
Mailing address:
  • Phone: 541-660-8787
  • Fax: 541-479-4643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number000865
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12368
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: