Individual
MS. KACEY ELIZABETH ODUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1011 SOMBRILLO CT, LOS ALAMOS, NM 87544-3259
(505) 661-0066
Mailing address
1011 SOMBRILLO CT, LOS ALAMOS, NM 87544-3259
(904) 535-4991
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
18-01385
KS
224Z00000X
Occupational Therapy Assistant
Primary
OTA12208
FL
Other
Enumeration date
12/06/2016
Last updated
12/06/2016
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