Provider Demographics
NPI:1902182900
Name:O'DONNELL, THERESA (COTA)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HILLSIDE TER
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-3707
Mailing Address - Country:US
Mailing Address - Phone:845-623-8095
Mailing Address - Fax:
Practice Address - Street 1:7 HILLSIDE TER
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-3707
Practice Address - Country:US
Practice Address - Phone:845-623-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-23
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007845-1224Z00000X
NJ46TA09080700224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant