Provider Demographics
NPI:1952978447
Name:ODONNELL, STEVEN JOHN (RRT,RPFT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JOHN
Last Name:ODONNELL
Suffix:
Gender:M
Credentials:RRT,RPFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:24 GREENBRIAR ROAD
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:508-587-7783
Mailing Address - Fax:
Practice Address - Street 1:1400 VFW PKWY
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132
Practice Address - Country:US
Practice Address - Phone:857-203-6442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MART11732279C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MART1173OtherCOMMONWEALTH OF MASSACHUSETTS RESPIRATORY THERAPY