Provider Demographics
NPI:1053746800
Name:ODA, LORI KAY (MS, AT, ATC)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:KAY
Last Name:ODA
Suffix:
Gender:F
Credentials:MS, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HILLCREST DR
Mailing Address - Street 2:EATON HIGH SCHOOL - ATHLETIC TRAINER
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-8501
Mailing Address - Country:US
Mailing Address - Phone:937-367-7002
Mailing Address - Fax:
Practice Address - Street 1:600 HILLCREST DR
Practice Address - Street 2:EATON HIGH SCHOOL - ATHLETIC TRAINER
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-8501
Practice Address - Country:US
Practice Address - Phone:937-367-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0025722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer