Provider Demographics
NPI:1164858791
Name:O'DONNELL, ELENA A (PTA)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:A
Last Name:O'DONNELL
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 1:11607 W WILKINSON ST
Mailing Address - Street 2:
Mailing Address - City:MAIZE
Mailing Address - State:KS
Mailing Address - Zip Code:67101-9011
Mailing Address - Country:US
Mailing Address - Phone:316-210-1462
Mailing Address - Fax:888-737-8795
Practice Address - Street 1:11607 W WILKINSON ST
Practice Address - Street 2:
Practice Address - City:MAIZE
Practice Address - State:KS
Practice Address - Zip Code:67101-9011
Practice Address - Country:US
Practice Address - Phone:316-210-1462
Practice Address - Fax:888-737-8795
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-14
Last Update Date:2013-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1402578225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant