Provider Demographics
NPI:1154892511
Name:O'DONNELL, KATHERINE (DPT)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 288
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-9608
Mailing Address - Country:US
Mailing Address - Phone:808-632-0033
Mailing Address - Fax:808-632-0077
Practice Address - Street 1:5633 KAWAIHU ROAD
Practice Address - Street 2:BLDG 2A-12
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746
Practice Address - Country:US
Practice Address - Phone:808-378-4477
Practice Address - Fax:808-632-0077
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24009225100000X
TX1306228225100000X
MI5501018701225100000X
HIPT-4833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist