Healthcare Provider Details

I. General information

NPI: 1619317526
Provider Name (Legal Business Name): COLLEEN ELIZABETH O'CONNELL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 CENTER RD
LYNDEBOROUGH NH
03082-6105
US

IV. Provider business mailing address

1124 CENTER RD
LYNDEBOROUGH NH
03082-6105
US

V. Phone/Fax

Practice location:
  • Phone: 603-769-1852
  • Fax:
Mailing address:
  • Phone: 603-769-1852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2316
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10810
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: