Provider Demographics
NPI:1225448897
Name:BODWELL, JACKIE (BS, RRT)
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:
Last Name:BODWELL
Suffix:
Gender:F
Credentials:BS, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 RANCH RD
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-1238
Mailing Address - Country:US
Mailing Address - Phone:317-538-3737
Mailing Address - Fax:
Practice Address - Street 1:910 RANCH RD
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-1238
Practice Address - Country:US
Practice Address - Phone:317-538-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN30005122A227900000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered