Provider Demographics
NPI:1679240980
Name:O'CONNELL, ANNA JOY (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:JOY
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5587 CALLCOTT WAY UNIT 1219
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-4010
Mailing Address - Country:US
Mailing Address - Phone:570-472-7127
Mailing Address - Fax:
Practice Address - Street 1:2601 18TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1301
Practice Address - Country:US
Practice Address - Phone:202-526-7982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP009706224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant