Provider Demographics
NPI:1740061514
Name:ODAT SERVICES L.L.C.
Entity type:Organization
Organization Name:ODAT SERVICES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:GANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-879-8920
Mailing Address - Street 1:3102 HOYT AVE UNIT 2371
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98213-0028
Mailing Address - Country:US
Mailing Address - Phone:425-879-8920
Mailing Address - Fax:
Practice Address - Street 1:3102 HOYT AVE UNIT 2371
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98213-0028
Practice Address - Country:US
Practice Address - Phone:425-879-8920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management