Provider Demographics
NPI:1073969788
Name:O'DELL, SARA J (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:O'DELL
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 NICOLA CROSSWAY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-9797
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 WORLDS FAIR DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1369
Practice Address - Country:US
Practice Address - Phone:732-537-0200
Practice Address - Fax:732-564-9020
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT00224800208100000X
PART0064382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation