Provider Demographics
NPI:1639189558
Name:ODA, IJEOMA NGOZI (MS OTR)
Entity Type:Individual
Prefix:
First Name:IJEOMA
Middle Name:NGOZI
Last Name:ODA
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:EJ
Other - Middle Name:
Other - Last Name:ODA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS OTR
Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:PM&R 117
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:214-857-1732
Mailing Address - Fax:214-857-1281
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:PM&R 117
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-1732
Practice Address - Fax:214-857-1281
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110001225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist