Basic Information
| Provider Information | |||||||||
| NPI: | 1952831075 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ODLE | ||||||||
| FirstName: | HALEY | ||||||||
| MiddleName: | RENEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 218 ELKWOOD AVE UNIT 103 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288042247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286843611 | ||||||||
| FaxNumber: | 8286843612 | ||||||||
| Practice Location | |||||||||
| Address1: | 218 ELKWOOD AVE UNIT 103 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288042247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286843611 | ||||||||
| FaxNumber: | 8286843612 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2017 | ||||||||
| LastUpdateDate: | 05/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 09566R | LA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | PTH8176 | AL | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 2305210713 | VA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 225100000X | P18896 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.