Provider Demographics
NPI:1689852980
Name:O'CONNELL, EILEEN MARIE (PT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARIE
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W CLINTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OAKLYN
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1500
Mailing Address - Country:US
Mailing Address - Phone:215-498-6056
Mailing Address - Fax:
Practice Address - Street 1:215 W CLINTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:OAKLYN
Practice Address - State:NJ
Practice Address - Zip Code:08107-1500
Practice Address - Country:US
Practice Address - Phone:215-498-6056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00803400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist