Individual
KELLIE ODENEAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
907 NW 5TH ST, WAGONER, OK 74467-3103
(918) 777-1241
Mailing address
907 NW 5TH ST, WAGONER, OK 74467-3103
(918) 777-1241
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
08/24/2022
Last updated
08/24/2022
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