Provider Demographics
NPI:1215798319
Name:O'DELL, JENNY ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:ELIZABETH
Last Name:O'DELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 ME-236
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903
Mailing Address - Country:US
Mailing Address - Phone:401-714-9485
Mailing Address - Fax:
Practice Address - Street 1:43 ME-236
Practice Address - Street 2:SUITE 5
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903
Practice Address - Country:US
Practice Address - Phone:401-714-9485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT3374225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist