Provider Demographics
NPI:1669473435
Name:O'CONNELL, KATHLEEN JO (DPM)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:JO
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-7239
Mailing Address - Country:US
Mailing Address - Phone:518-891-9161
Mailing Address - Fax:518-891-9187
Practice Address - Street 1:136 BROADWAY STE 3
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1404
Practice Address - Country:US
Practice Address - Phone:518-891-9161
Practice Address - Fax:518-891-9187
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY005763213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine