Provider Demographics
NPI:1235207705
Name:O'DONNELL, LAUREN J (OT)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:J
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:J
Other - Last Name:SHERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 34990
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:834 CHESTNUT ST
Practice Address - Street 2:SUITE G114
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5127
Practice Address - Country:US
Practice Address - Phone:215-321-3000
Practice Address - Fax:215-321-3002
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002176L225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2138764000OtherIBC- KEYSTONE
PA1452899OtherIBC - PERSONAL CHOICE