Provider Demographics
NPI:1871747568
Name:O'DONNELL, RICHARD (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0N511 ARBOR CT
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1199
Mailing Address - Country:US
Mailing Address - Phone:630-221-0883
Mailing Address - Fax:
Practice Address - Street 1:0N511 ARBOR CT
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1199
Practice Address - Country:US
Practice Address - Phone:630-221-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-09
Last Update Date:2008-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.007497225700000X
NH1759M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist