Provider Demographics
NPI:1952831075
Name:ODLE, HALEY RENEE
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:RENEE
Last Name:ODLE
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 1:218 ELKWOOD AVE UNIT 103
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-2247
Mailing Address - Country:US
Mailing Address - Phone:828-684-3611
Mailing Address - Fax:828-684-3612
Practice Address - Street 1:218 ELKWOOD AVE UNIT 103
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-2247
Practice Address - Country:US
Practice Address - Phone:828-684-3611
Practice Address - Fax:828-684-3612
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09566R208100000X
ALPTH8176208100000X
VA2305210713208100000X
NCP18896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation