Provider Demographics
NPI:1952190613
Name:O'DELL, EMMALEE GRACE
Entity type:Individual
Prefix:
First Name:EMMALEE
Middle Name:GRACE
Last Name:O'DELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 S CLINE AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-6831
Mailing Address - Country:US
Mailing Address - Phone:660-752-6227
Mailing Address - Fax:
Practice Address - Street 1:533 BUTTERFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST FORK
Practice Address - State:AR
Practice Address - Zip Code:72774-2530
Practice Address - Country:US
Practice Address - Phone:870-688-3426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician