Provider Demographics
NPI:1063710515
Name:MACDONNELL, ROBERT EDWARD (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDWARD
Last Name:MACDONNELL
Suffix:
Gender:M
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 FETTLER PARK
Mailing Address - Street 2:DUMFRIES HEALTH CENTER
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025
Mailing Address - Country:US
Mailing Address - Phone:703-441-7500
Mailing Address - Fax:
Practice Address - Street 1:700 FETTLER PARK
Practice Address - Street 2:DUMFRIES HEALTH CENTER
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025
Practice Address - Country:US
Practice Address - Phone:703-441-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002314171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider