Provider Demographics
NPI:1609609882
Name:ODIMEGWU, CHIDIMMA KELLY (OT)
Entity type:Individual
Prefix:
First Name:CHIDIMMA
Middle Name:KELLY
Last Name:ODIMEGWU
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 SOUTH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1565
Mailing Address - Country:US
Mailing Address - Phone:508-205-2655
Mailing Address - Fax:
Practice Address - Street 1:513 SOUTH ST STE 203
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1565
Practice Address - Country:US
Practice Address - Phone:508-205-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist