Provider Demographics
NPI:1457467870
Name:ODOM, LOLLI K (OT)
Entity Type:Individual
Prefix:
First Name:LOLLI
Middle Name:K
Last Name:ODOM
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 YELLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3767
Mailing Address - Country:US
Mailing Address - Phone:281-991-5983
Mailing Address - Fax:
Practice Address - Street 1:3800 SPENCER HWY
Practice Address - Street 2:STE F
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1251
Practice Address - Country:US
Practice Address - Phone:713-943-8573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105350225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist