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General NPI Number Information
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NPI Number | 1922097997
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Entity Type | Individual
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Provider Name | JACQUELINE ANN ODELL PT
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Gender | Female
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 9612 270TH ST NW
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City | STANWOOD
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State | WA
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Zip | 98292-1906
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Country | US
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Telephone | 360-629-8043
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Fax | 360-629-8053
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Provider Business Mailing Address
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Address Line | 9612 270TH ST NW
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City | STANWOOD
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State | WA
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Zip | 98292-1906
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Country | US
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Telephone | 360-629-8043
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Fax | 360-629-8053
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT00002424
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License Number State | WA
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