Provider Demographics
NPI:1730454356
Name:O'DONNELL, RYAN LEE (BCABA)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:LEE
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 COSMOS DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-4929
Mailing Address - Country:US
Mailing Address - Phone:775-482-4112
Mailing Address - Fax:
Practice Address - Street 1:245 COSMOS DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-4929
Practice Address - Country:US
Practice Address - Phone:775-482-4112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst