MEDICARE: LOLLI K. ODOM OT

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	225X00000X	Occupational Therapist	105350	TX

General Provider Information

NPI Number	:	1457467870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOLLI K. ODOM OT

Provider Business Mailing Address
First Line	:	4811 YELLOWSTONE DR
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77505-3767
Country	:	US
Telephone Number	:	281-991-5983
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 SPENCER HWY
Second Line	:	STE F
City	:	PASADENA
State	:	TX
Zip	:	77504-1251
Country	:	US
Telephone Number	:	713-943-8573
Fax Number	:

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	02/06/2009

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