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NPI Code Detail

MEDICARE: KATHRYN S O'DELL

MEDICARE: KATHRYN S O'DELL
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
1225X00000XOccupational Therapist

General Provider Information

NPI Number : 1871286021
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN S O'DELL
Provider Business Mailing Address
First Line : 191 MAPLE AVE
Second Line :
City : UNCASVILLE
State : CT
Zip : 06382-2017
Country : US
Telephone Number : 716-307-1599
Fax Number :
Provider Business Practice Location Address
First Line : 2099 W RIDGE RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14626-2728
Country : US
Telephone Number : 716-307-1599
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2023
Last Update Date : 06/01/2023

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