Provider Demographics
NPI:1235207705
Name:O'DONNELL, LAUREN J (OT)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:J
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:J
Other - Last Name:SHERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:700 S HENDERSON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3530
Mailing Address - Country:US
Mailing Address - Phone:610-768-5940
Mailing Address - Fax:610-768-5947
Practice Address - Street 1:834 CHESTNUT ST
Practice Address - Street 2:SUITE G114
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5127
Practice Address - Country:US
Practice Address - Phone:215-321-3000
Practice Address - Fax:215-321-3002
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002176L225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2138764000OtherIBC- KEYSTONE
PA1452899OtherIBC - PERSONAL CHOICE