Provider Demographics
NPI:1023201183
Name:ODOM, JANICE ARLENE (LMT)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:ARLENE
Last Name:ODOM
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 1:15534 SE 58TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:MICANOPY
Mailing Address - State:FL
Mailing Address - Zip Code:32667
Mailing Address - Country:US
Mailing Address - Phone:352-328-1544
Mailing Address - Fax:
Practice Address - Street 1:200 NE 1ST STREET
Practice Address - Street 2:SUITE 117
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601
Practice Address - Country:US
Practice Address - Phone:352-328-1544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49915225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist