Provider Demographics
NPI:1922375302
Name:O'DELL, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:O'DELL
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:PO BOX 3510
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-3510
Mailing Address - Country:US
Mailing Address - Phone:970-708-1048
Mailing Address - Fax:
Practice Address - Street 1:2016 OLD ELAM RANCH ROAD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CO
Practice Address - Zip Code:81430
Practice Address - Country:US
Practice Address - Phone:970-708-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2275225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist