Provider Demographics
NPI:1992960512
Name:ODONNELL, KATHERINE MARY (LMT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CENTRAL AVENUE
Mailing Address - Street 2:COLUMBIA PROFESSIONAL MEDICAL BUILDING
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086
Mailing Address - Country:US
Mailing Address - Phone:716-683-5012
Mailing Address - Fax:
Practice Address - Street 1:450 CENTRAL AVENUE
Practice Address - Street 2:COLUMBIA PROFESSIONAL MEDICAL BUILDING
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086
Practice Address - Country:US
Practice Address - Phone:716-683-5012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014070225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist