MEDICARE: MEAGAN ODELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	0014443	CO

General Provider Information

NPI Number	:	1134771280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGAN ODELL

Provider Business Mailing Address
First Line	:	4542 E UTAH PL
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-4429
Country	:	US
Telephone Number	:	303-378-1092
Fax Number	:

Provider Business Practice Location Address
First Line	:	4542 E UTAH PL
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-4429
Country	:	US
Telephone Number	:	303-378-1092
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	07/09/2019

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Directions to “ MEAGAN ODELL ” Practice Location

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