Healthcare Provider Details

I. General information

NPI: 1780640888
Provider Name (Legal Business Name): MEGHAN O'DONNELL-PARKS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TABOR ACADEMY
MARION MA
02738
US

IV. Provider business mailing address

11 ICHABOD LN
MARION MA
02738-1003
US

V. Phone/Fax

Practice location:
  • Phone: 508-748-2000
  • Fax:
Mailing address:
  • Phone: 508-748-2308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number811
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: