MEDICARE: ALICIA O'DONNELL M.M.P., C.M.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	0019005481	VA

General Provider Information

NPI Number	:	1235364837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA O'DONNELL M.M.P., C.M.T.

Provider Business Mailing Address
First Line	:	4238 WILSON BLVD
Second Line	:	2264
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1823
Country	:	US
Telephone Number	:	571-214-1353
Fax Number	:

Provider Business Practice Location Address
First Line	:	4238 WILSON BLVD
Second Line	:	2264
City	:	ARLINGTON
State	:	VA
Zip	:	22203-1823
Country	:	US
Telephone Number	:	571-214-1353
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2009
Last Update Date	:	05/26/2009

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