Basic Information
| Provider Information | |||||||||
| NPI: | 1235207705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'DONNELL | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHERRY | ||||||||
| OtherFirstName: | LAUREN | ||||||||
| OtherMiddleName: | J | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | OT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 700 S HENDERSON RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194063530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6107685940 | ||||||||
| FaxNumber: | 6107685947 | ||||||||
| Practice Location | |||||||||
| Address1: | 834 CHESTNUT ST | ||||||||
| Address2: | SUITE G114 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153213000 | ||||||||
| FaxNumber: | 2153213002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 08/23/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | OC002176L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225X00000X | OC002176L | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2138764000 | 01 | PA | IBC- KEYSTONE | OTHER | 1452899 | 01 | PA | IBC - PERSONAL CHOICE | OTHER |