Provider Demographics
NPI:1376892752
Name:O'CONNELL, CHERYL ANN (OTR)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:BRINKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:13345 W BURLEIGH RD
Mailing Address - Street 2:APARTMENT 4
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-3071
Mailing Address - Country:US
Mailing Address - Phone:414-406-2182
Mailing Address - Fax:
Practice Address - Street 1:13345 W BURLEIGH RD
Practice Address - Street 2:APARTMENT 4
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-3071
Practice Address - Country:US
Practice Address - Phone:414-406-2182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1311-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist