Provider Demographics
NPI:1598729048
Name:O'CONNOR, RICHARD M (MA, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:M
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:MA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MORSE DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-8379
Mailing Address - Country:US
Mailing Address - Phone:423-652-4754
Mailing Address - Fax:423-652-6041
Practice Address - Street 1:129 MORSE DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-8379
Practice Address - Country:US
Practice Address - Phone:423-652-4754
Practice Address - Fax:423-652-6041
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10022255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer