MEDICARE: MS. CHRISTINE ANN O'DONNELL PT

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	2251X0800X	Orthopedic Physical Therapist	5501004862	MI

General Provider Information

NPI Number	:	1851624902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE ANN O'DONNELL PT

Provider Business Mailing Address
First Line	:	1333 SPRING ST
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8720
Country	:	US
Telephone Number	:	231-487-4638
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 SPRING ST
Second Line	:
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8720
Country	:	US
Telephone Number	:	231-487-4638
Fax Number	:

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

Provider Enumeration Date	:	09/08/2009
Last Update Date	:	09/08/2009

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