Provider Demographics
NPI:1750033122
Name:ODOOM, JELORD
Entity Type:Individual
Prefix:
First Name:JELORD
Middle Name:
Last Name:ODOOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 DERBYDALE RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-4039
Mailing Address - Country:US
Mailing Address - Phone:234-863-8292
Mailing Address - Fax:
Practice Address - Street 1:1273 DERBYDALE RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-4039
Practice Address - Country:US
Practice Address - Phone:234-863-8292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker