Provider Demographics
NPI:1841704285
Name:O'CONNELL, KEVIN BRYON (LMT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:BRYON
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 MIDDLETOWN BLVD STE 508
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1840
Mailing Address - Country:US
Mailing Address - Phone:215-741-4410
Mailing Address - Fax:215-741-4470
Practice Address - Street 1:370 MIDDLETOWN BLVD STE 508
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1840
Practice Address - Country:US
Practice Address - Phone:215-741-4410
Practice Address - Fax:215-741-4470
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG007305225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist