Provider Demographics
NPI:1215982848
Name:O'DELL, ANNABELLE MAGNO
Entity type:Individual
Prefix:
First Name:ANNABELLE
Middle Name:MAGNO
Last Name:O'DELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 CEDAR LANE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-9739
Mailing Address - Country:US
Mailing Address - Phone:727-515-2095
Mailing Address - Fax:
Practice Address - Street 1:4709 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5007
Practice Address - Country:US
Practice Address - Phone:302-998-9880
Practice Address - Fax:302-998-7498
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE018952D81Medicare ID - Type Unspecified
Q64448Medicare UPIN