Provider Demographics
NPI:1629312491
Name:O'DELL, SARA NICOLE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:NICOLE
Last Name:O'DELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 ODELL RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-9250
Mailing Address - Country:US
Mailing Address - Phone:864-923-9611
Mailing Address - Fax:
Practice Address - Street 1:283 ODELL RD
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-9250
Practice Address - Country:US
Practice Address - Phone:864-923-9611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3994225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist