Healthcare Provider Details

I. General information

NPI: 1952978447
Provider Name (Legal Business Name): STEVEN JOHN ODONNELL RRT,RPFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY
WEST ROXBURY MA
02132
US

IV. Provider business mailing address

24 GREENBRIAR ROAD
BROCKTON MA
02301
US

V. Phone/Fax

Practice location:
  • Phone: 857-203-6442
  • Fax:
Mailing address:
  • Phone: 508-587-7783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberRT1173
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: