Provider Demographics
NPI:1841430543
Name:ODELL, SUSAN H (OTR)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:H
Last Name:ODELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 STAFFORD DR
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-5333
Mailing Address - Country:US
Mailing Address - Phone:518-907-4326
Mailing Address - Fax:
Practice Address - Street 1:151 STAFFORD DR
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-5333
Practice Address - Country:US
Practice Address - Phone:518-907-4326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005380-1172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker