Provider Demographics
NPI:1447695192
Name:O'CONNOR, DENELL L (LMP)
Entity type:Individual
Prefix:MRS
First Name:DENELL
Middle Name:L
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 36TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1312
Mailing Address - Country:US
Mailing Address - Phone:206-723-2820
Mailing Address - Fax:206-722-3664
Practice Address - Street 1:4236 36TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1312
Practice Address - Country:US
Practice Address - Phone:206-723-2820
Practice Address - Fax:206-722-3664
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60364840225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist