Provider Demographics
NPI:1871831073
Name:ODGERS, JEBEL BROOKE
Entity Type:Individual
Prefix:
First Name:JEBEL
Middle Name:BROOKE
Last Name:ODGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEBEL
Other - Middle Name:BROOKE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPTA
Mailing Address - Street 1:5220 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-2500
Mailing Address - Country:US
Mailing Address - Phone:785-231-9942
Mailing Address - Fax:
Practice Address - Street 1:5220 SW 17TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-2500
Practice Address - Country:US
Practice Address - Phone:785-231-9942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1402377225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant