Provider Demographics
NPI:1033344932
Name:O'DONNELL, CRYSTAL MICHELLE (DT)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:MICHELLE
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4757 SCHMIDT RD
Mailing Address - Street 2:
Mailing Address - City:MILLSTADT
Mailing Address - State:IL
Mailing Address - Zip Code:62260-3321
Mailing Address - Country:US
Mailing Address - Phone:618-604-8669
Mailing Address - Fax:
Practice Address - Street 1:4757 SCHMIDT RD
Practice Address - Street 2:
Practice Address - City:MILLSTADT
Practice Address - State:IL
Practice Address - Zip Code:62260-3321
Practice Address - Country:US
Practice Address - Phone:618-604-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist