Provider Demographics
NPI:1780640888
Name:O'DONNELL-PARKS, MEGHAN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:
Last Name:O'DONNELL-PARKS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ICHABOD LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-1003
Mailing Address - Country:US
Mailing Address - Phone:508-748-2308
Mailing Address - Fax:
Practice Address - Street 1:TABOR ACADEMY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738
Practice Address - Country:US
Practice Address - Phone:508-748-2000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer