Individual
KEALA LASHAUN ODOMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSHSA, OTR/L
Contact information
Practice address
3605 RATLIFF RD, BIRMINGHAM, AL 35210-4512
(205) 956-7133
Mailing address
6769 DEER FOOT DR, PINSON, AL 35126-6202
(205) 305-7120
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2059
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2059
LICENSURE / CERTIFICATION BOARD FOR OCCUPATIONAL THERAPY
AL
Enumeration date
02/29/2012
Last updated
02/29/2012
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