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NPI Code Detail

MEDICARE: MISS KARIN O'DONNELL MPT, DPT

MEDICARE: MISS KARIN O'DONNELL MPT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist070013032IL

General Provider Information

NPI Number : 1386964229
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KARIN O'DONNELL MPT, DPT
Provider Business Mailing Address
First Line : 5905 W WASHINGTON BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60644-2845
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5905 W WASHINGTON BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60644-2845
Country : US
Telephone Number : 773-261-7074
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2010
Last Update Date : 06/02/2010

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