Provider Demographics
NPI:1164858296
Name:O'DELL, LINDSEY LEIGH (OTR)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:LEIGH
Last Name:O'DELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24244 COUNTY ROAD 126
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-8725
Mailing Address - Country:US
Mailing Address - Phone:574-274-8452
Mailing Address - Fax:
Practice Address - Street 1:24244 COUNTY ROAD 126
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-8725
Practice Address - Country:US
Practice Address - Phone:574-274-8452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004087225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist