Provider Demographics
NPI:1285114355
Name:ODUM, ONYINYECHUKWU ISIOMA (OTR/L)
Entity type:Individual
Prefix:
First Name:ONYINYECHUKWU
Middle Name:ISIOMA
Last Name:ODUM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 HUMMINGBIRD WAY
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4306
Mailing Address - Country:US
Mailing Address - Phone:214-254-7909
Mailing Address - Fax:
Practice Address - Street 1:3505 S BUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-5451
Practice Address - Country:US
Practice Address - Phone:214-254-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118796225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist