Provider Demographics
NPI:1508133877
Name:MCCONNELL, PATRICK GERARD (OT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:GERARD
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 PEPPER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1705
Mailing Address - Country:US
Mailing Address - Phone:630-208-8174
Mailing Address - Fax:
Practice Address - Street 1:2312 PEPPER VALLEY DR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-1705
Practice Address - Country:US
Practice Address - Phone:630-208-8174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056001833225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist