MEDICARE: DR. KATHLEEN JO O'CONNELL D.P.M.

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
1	213EP1101X	Primary Podiatric Medicine Podiatrist	005763	NY

General Provider Information

NPI Number	:	1669473435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN JO O'CONNELL D.P.M.

Provider Business Mailing Address
First Line	:	PO BOX 1239
Second Line	:
City	:	SARANAC LAKE
State	:	NY
Zip	:	12983-7239
Country	:	US
Telephone Number	:	518-891-9161
Fax Number	:	518-891-9187

Provider Business Practice Location Address
First Line	:	136 BROADWAY STE 3
Second Line	:
City	:	SARANAC LAKE
State	:	NY
Zip	:	12983-1404
Country	:	US
Telephone Number	:	518-891-9161
Fax Number	:	518-891-9187

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	05/20/2025

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