Provider Demographics
NPI:1245313998
Name:O'DONNELL, JOHN JAMES (ATC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JAMES
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:BOOTHWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19061-2488
Mailing Address - Country:US
Mailing Address - Phone:484-680-4713
Mailing Address - Fax:
Practice Address - Street 1:107 LOUISE DR
Practice Address - Street 2:
Practice Address - City:BOOTHWYN
Practice Address - State:PA
Practice Address - Zip Code:19061-2488
Practice Address - Country:US
Practice Address - Phone:484-680-4713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001565A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer