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General NPI Number Information
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NPI Number | 1336640077
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Entity Type | Individual
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Provider Name | COLLEEN O'DONNELL
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Gender | Female
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 02/27/2018
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Provider Practice Location Address
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Address Line | 29200 SCHOOLCRAFT RD
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City | LIVONIA
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State | MI
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Zip | 48150-2228
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Country | US
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Telephone | 734-523-1070
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Fax |
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Provider Business Mailing Address
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Address Line | 15022 OXFORD CT
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City | SOUTHGATE
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State | MI
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Zip | 48195-2325
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Country | US
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Telephone | 734-771-2782
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XL0004X
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Taxonomy Name | Low Vision Occupational Therapist
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License Number | 5201002280
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License Number State | MI
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