Provider Demographics
NPI:1023223799
Name:ODIAN, PAUL ARMEN
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ARMEN
Last Name:ODIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 381
Mailing Address - Street 2:
Mailing Address - City:SOAP LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98851-0381
Mailing Address - Country:US
Mailing Address - Phone:509-246-1660
Mailing Address - Fax:
Practice Address - Street 1:318 MAIN AVE
Practice Address - Street 2:
Practice Address - City:SOAP LAKE
Practice Address - State:WA
Practice Address - Zip Code:98851-0381
Practice Address - Country:US
Practice Address - Phone:509-246-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014406225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist