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General NPI Number Information
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NPI Number | 1093301400
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Entity Type | Individual
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Provider Name | ODESSA RENE BRADLEY HOMEHEALTH
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Gender | Female
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Dates
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Enumeration Date | 12/19/2020
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 601 US HIGHWAY 278 BYP E
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City | PIEDMONT
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State | AL
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Zip | 36272-1457
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Country | US
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Telephone | 256-499-3765
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Fax |
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Provider Business Mailing Address
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Address Line | 601 US HIGHWAY 278 BYP E
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City | PIEDMONT
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State | AL
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Zip | 36272-1457
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Country | US
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Telephone | 256-499-3765
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 20213979
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 20213537
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 4179
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License Number State | AL
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