Provider Demographics
NPI:1124256227
Name:O'CONNELL, DAVID B
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 CAMBRIDGE ST # 1
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2803
Mailing Address - Country:US
Mailing Address - Phone:617-783-1600
Mailing Address - Fax:
Practice Address - Street 1:705 CAMBRIDGE ST # 1
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2803
Practice Address - Country:US
Practice Address - Phone:617-783-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4728225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist