Individual
KRISTA L O'DELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1504 MADISON AVE, FORT ATKINSON, WI 53538-3100
(920) 563-9357
Mailing address
1504 MADISON AVE, FORT ATKINSON, WI 53538-3100
(920) 563-9357
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12190-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36113400
—
WI
Enumeration date
10/03/2012
Last updated
01/21/2015
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