MEDICARE: KAREN JEANNE O'DONNELL OTR/L

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	225XP0200X	Pediatric Occupational Therapist	00000143	WA

General Provider Information

NPI Number	:	1912348558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN JEANNE O'DONNELL OTR/L

Provider Business Mailing Address
First Line	:	2210 66TH AVE NE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-1501
Country	:	US
Telephone Number	:	360-352-8124
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 66TH AVE NE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-1501
Country	:	US
Telephone Number	:	360-352-8124
Fax Number	:

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

Provider Enumeration Date	:	07/11/2013
Last Update Date	:	07/11/2013

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