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General NPI Number Information
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NPI Number | 1568091304
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Entity Type | Individual
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Provider Name | TIMOTHY O'DONNELL ATC
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Gender | Male
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 301 2ND AVE
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City | HADDON HEIGHTS
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State | NJ
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Zip | 08035-1407
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Country | US
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Telephone | 856-547-1920
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Fax |
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Provider Business Mailing Address
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Address Line | 1139 NEWTON AVE
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City | OAKLYN
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State | NJ
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Zip | 08107-1067
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Country | US
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Telephone | 609-870-0104
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00114200
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License Number State | NJ
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