Individual
TEQUIA ODOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1825 SEATON RD, RAYMOND, MS 39154-9415
(601) 951-8913
Mailing address
1825 SEATON RD, RAYMOND, MS 39154-9415
(601) 951-8913
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
347C00000X
Private Vehicle
800963665
MS
Other
Enumeration date
02/21/2017
Last updated
02/21/2017
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