MEDICARE: CHRISTOPHER JOHN O'DELL OTA/L

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	225XP0019X	Physical Rehabilitation Occupational Therapist	269240	KY

General Provider Information

NPI Number	:	1669138418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER JOHN O'DELL OTA/L

Provider Business Mailing Address
First Line	:	932 BERNARD AVE
Second Line	:
City	:	FINDLAY
State	:	OH
Zip	:	45840-5562
Country	:	US
Telephone Number	:	419-429-9490
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 STERLING DR
Second Line	:
City	:	NORTH BALTIMORE
State	:	OH
Zip	:	45872-9508
Country	:	US
Telephone Number	:	419-257-2421
Fax Number	:

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

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	11/15/2021

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