=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215982848
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNABELLE MAGNO O'DELL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2006
-----------------------------------------------------
Last Update Date | 12/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4709 KIRKWOOD HWY
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19808-5007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-998-9880
-----------------------------------------------------
Fax | 302-998-7498
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1240 CEDAR LANE RD
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19709-9739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-515-2095
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | J1-0002028
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------