Provider Demographics
NPI:1497780365
Name:O'DONNELL, JENNIFER (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
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 1:1900 LAFAYETTE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5679
Mailing Address - Country:US
Mailing Address - Phone:603-431-5600
Mailing Address - Fax:603-431-5610
Practice Address - Street 1:1900 LAFAYETTE RD
Practice Address - Street 2:SUITE C
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5679
Practice Address - Country:US
Practice Address - Phone:603-431-5600
Practice Address - Fax:603-431-5610
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196281225100000X
NH3308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA196281OtherPT LICENSE
NH3308OtherNH LICENSE