Healthcare Provider Details

I. General information

NPI: 1043322928
Provider Name (Legal Business Name): THOMAS WILLIAM O'DONNELL CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SOUTH HUNTINGTON AVE
BOSTON MA
02130
US

IV. Provider business mailing address

59 STOCKHOLM AVE
ROCKPORT MA
01966-1276
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-9500
  • Fax: 857-364-4537
Mailing address:
  • Phone: 978-546-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO 1633
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: