Provider Demographics
NPI:1942429519
Name:TAYLOR, ODETTE SUSAN (PT)
Entity Type:Individual
Prefix:MS
First Name:ODETTE
Middle Name:SUSAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ODETTE
Other - Middle Name:NEHRING
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:67 SYDNEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452
Mailing Address - Country:US
Mailing Address - Phone:802-872-0873
Mailing Address - Fax:
Practice Address - Street 1:3 HOME HEALTH CIRCLE
Practice Address - Street 2:
Practice Address - City:ST ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478
Practice Address - Country:US
Practice Address - Phone:802-527-7531
Practice Address - Fax:802-527-7533
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003286225100000X
MEPT305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist