Provider Demographics
NPI:1649756149
Name:ODLE, OLESIA L
Entity Type:Individual
Prefix:
First Name:OLESIA
Middle Name:L
Last Name:ODLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 GALAX AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3249
Mailing Address - Country:US
Mailing Address - Phone:864-430-7118
Mailing Address - Fax:
Practice Address - Street 1:306 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2725
Practice Address - Country:US
Practice Address - Phone:828-236-1547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician