Provider Demographics
NPI:1780620187
Name:MACDONELL, AIMEE ELIZABETH I (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:ELIZABETH
Last Name:MACDONELL
Suffix:I
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:AIMEE
Other - Middle Name:ELIZABETH
Other - Last Name:PADDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR /L
Mailing Address - Street 1:805 SW INDUSTRIAL WAY
Mailing Address - Street 2:STE 3
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1093
Mailing Address - Country:US
Mailing Address - Phone:541-585-2529
Mailing Address - Fax:541-585-2536
Practice Address - Street 1:1303 NE CUSHING DR
Practice Address - Street 2:STE 150
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3891
Practice Address - Country:US
Practice Address - Phone:541-382-7875
Practice Address - Fax:541-382-2181
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1005205225X00000X
WAOT00002501225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR230787Medicaid
ORR168771Medicare PIN