Provider Demographics
NPI:1326220096
Name:ODELL, CYNTHIA LOUISE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:ODELL
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 1:315 WEST EVANS CREEK RD # 71
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537
Mailing Address - Country:US
Mailing Address - Phone:541-660-8787
Mailing Address - Fax:541-479-4643
Practice Address - Street 1:141 SW G ST.
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526
Practice Address - Country:US
Practice Address - Phone:541-660-8787
Practice Address - Fax:541-479-4643
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000865133N00000X
OR12368225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No133N00000XDietary & Nutritional Service ProvidersNutritionist