Provider Demographics
NPI:1669653390
Name:O'CONNELL, MYRA LYNN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:LYNN
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MYRA
Other - Middle Name:
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:29822 RUNNING DEER LN
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2027
Mailing Address - Country:US
Mailing Address - Phone:949-363-7418
Mailing Address - Fax:
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA
Practice Address - Street 2:SUITE 400
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3616
Practice Address - Country:US
Practice Address - Phone:949-587-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-22
Last Update Date:2007-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1074261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy