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General NPI Number Information
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NPI Number | 1871747568
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Entity Type | Individual
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Provider Name | RICHARD O'DONNELL MASSAGE THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 11/09/2008
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Last Update Date | 11/09/2008
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Provider Practice Location Address
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Address Line | 0N511 ARBOR CT
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City | WINFIELD
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State | IL
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Zip | 60190-1199
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Country | US
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Telephone | 630-221-0883
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Fax |
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Provider Business Mailing Address
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Address Line | 0N511 ARBOR CT
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City | WINFIELD
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State | IL
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Zip | 60190-1199
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Country | US
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Telephone | 630-221-0883
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227.007497
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 1759M
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License Number State | NH
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