Provider Demographics
NPI:1295989713
Name:O'DONOHUE, LAUREN ALISSON (PTA)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ALISSON
Last Name:O'DONOHUE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1122
Mailing Address - Street 2:
Mailing Address - City:WURTSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12790-1122
Mailing Address - Country:US
Mailing Address - Phone:845-888-4409
Mailing Address - Fax:
Practice Address - Street 1:404 E HARFORD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1028
Practice Address - Country:US
Practice Address - Phone:570-409-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE008228225200000X
NY006073-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant