Provider Demographics
NPI:1942355474
Name:O'CONNELL-ILL, COLLEEN (OTRL)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:O'CONNELL-ILL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5906 WOODFIELD CT
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-6069
Mailing Address - Country:US
Mailing Address - Phone:816-728-0719
Mailing Address - Fax:
Practice Address - Street 1:11900 W 87TH STREET PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2807
Practice Address - Country:US
Practice Address - Phone:913-747-6100
Practice Address - Fax:913-747-6101
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004388225X00000X
FL10726225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist