Provider Demographics
NPI:1619317526
Name:O'CONNELL, COLLEEN ELIZABETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:LYNDEBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03082-6105
Mailing Address - Country:US
Mailing Address - Phone:603-769-1852
Mailing Address - Fax:
Practice Address - Street 1:1124 CENTER RD
Practice Address - Street 2:
Practice Address - City:LYNDEBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03082-6105
Practice Address - Country:US
Practice Address - Phone:603-769-1852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2316225X00000X
MA10810225X00000X
CA12093225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist