Provider Demographics
NPI:1154922847
Name:O'DONNELL, JASMINE (OTR/L)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 W PALMER BLVD # 103
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2830
Mailing Address - Country:US
Mailing Address - Phone:773-699-4955
Mailing Address - Fax:
Practice Address - Street 1:1820 W WEBSTER AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4892
Practice Address - Country:US
Practice Address - Phone:773-699-4955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.013937225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist