Provider Demographics
NPI:1538203310
Name:OCONNELL, SUSAN P (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:OCONNELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14701 E EXPOSITION AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2623
Mailing Address - Country:US
Mailing Address - Phone:303-699-6442
Mailing Address - Fax:
Practice Address - Street 1:14701 E EXPOSITION AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2623
Practice Address - Country:US
Practice Address - Phone:303-699-6442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
003925OtherKAISER-COMMERCIAL NUMBER