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General NPI Number Information
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NPI Number | 1669653390
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Entity Type | Individual
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Provider Name | MYRA LYNN O'CONNELL OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/22/2007
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Last Update Date | 11/22/2007
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Provider Practice Location Address
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Address Line | 23961 CALLE DE LA MAGDALENA SUITE 400
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3616
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Country | US
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Telephone | 949-587-1155
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Fax |
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Provider Business Mailing Address
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Address Line | 29822 RUNNING DEER LN
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-2027
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Country | US
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Telephone | 949-363-7418
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1074
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License Number State | CA
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