Provider Demographics
NPI:1174952709
Name:ODEA, HEATHER (OTR)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:ODEA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5596 CATHEDRAL DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2801
Mailing Address - Country:US
Mailing Address - Phone:989-529-0112
Mailing Address - Fax:
Practice Address - Street 1:5596 CATHEDRAL DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2801
Practice Address - Country:US
Practice Address - Phone:989-529-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004408314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility