Provider Demographics
NPI:1326703182
Name:ODONNELL, MICHELLE L (OTR)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 DRUMMOND DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3749
Mailing Address - Country:US
Mailing Address - Phone:518-226-2120
Mailing Address - Fax:
Practice Address - Street 1:HOME OF THE GOOD SHEPARD
Practice Address - Street 2:26 ROCKROSE WAY
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020
Practice Address - Country:US
Practice Address - Phone:518-581-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006907-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty