Provider Demographics
NPI:1275666174
Name:O'DONNELL, NANCY BRAUER (PT)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:BRAUER
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MONTCLAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4509
Mailing Address - Country:US
Mailing Address - Phone:301-695-5800
Mailing Address - Fax:301-695-3139
Practice Address - Street 1:700 MONTCLAIRE AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4509
Practice Address - Country:US
Practice Address - Phone:301-695-5800
Practice Address - Fax:301-695-3139
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7972016Medicaid
MDT8920001OtherBLUE CROSS BLUE SHIELD
MD52-1734544OtherUNITED HEALTHCARE
MD7972016Medicaid
R93463Medicare UPIN