Individual
TIFFANY SHANAE ODUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
100 EMANCIPATION DR, HAMPTON, VA 23667-0001
(757) 722-9961
Mailing address
1801 GILDA CT, VIRGINIA BEACH, VA 23464-6528
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3529
AL
Other
Enumeration date
05/09/2013
Last updated
05/09/2013
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