Provider Demographics
NPI:1982815502
Name:O'DONNELL, LINDA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 PITTROFF AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-2238
Mailing Address - Country:US
Mailing Address - Phone:413-533-2793
Mailing Address - Fax:
Practice Address - Street 1:112 PITTROFF AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-2238
Practice Address - Country:US
Practice Address - Phone:413-533-2793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility