Basic Information
| Provider Information | |||||||||
| NPI: | 1215982848 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'DELL | ||||||||
| FirstName: | ANNABELLE | ||||||||
| MiddleName: | MAGNO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1240 CEDAR LANE RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197099739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275152095 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4709 KIRKWOOD HWY | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198085007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3029989880 | ||||||||
| FaxNumber: | 3029987498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 12/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | J1-0002028 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.