Provider Demographics
NPI:1174239529
Name:ODELL, KELSI (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KELSI
Middle Name:
Last Name:ODELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-8256
Mailing Address - Country:US
Mailing Address - Phone:918-237-8520
Mailing Address - Fax:
Practice Address - Street 1:2022 CEDAR CT
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-8256
Practice Address - Country:US
Practice Address - Phone:918-237-8520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist