Provider Demographics
NPI:1346204237
Name:ODELL, LAUREN QUIGLEY (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:QUIGLEY
Last Name:ODELL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4841
Mailing Address - Country:US
Mailing Address - Phone:860-871-2508
Mailing Address - Fax:860-871-1478
Practice Address - Street 1:428 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4841
Practice Address - Country:US
Practice Address - Phone:860-871-2508
Practice Address - Fax:860-871-1478
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080007724CT03OtherANTHEM BC/BS
CT080007724CT03OtherANTHEM BC/BS