Provider Demographics
NPI:1821279076
Name:O'CONNELL, MARGARET ANN (OTR)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ANN
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 S DAHLIA CIR APT N-306
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3319
Mailing Address - Country:US
Mailing Address - Phone:303-808-4431
Mailing Address - Fax:
Practice Address - Street 1:630 S DAHLIA CIR APT N-306
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-3319
Practice Address - Country:US
Practice Address - Phone:303-808-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01785885Medicaid