Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT011676L | PA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT011676L | PA |
NPI | 1003071291 |
---|---|
Provider Name | Clarissa Thurman O'donnell |
First Address | Harrisburg, PA 17111-3576 |
Second Address | Mechanicsburg, PA 17050-3300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2008 |
Last Update Date | 30/11/2015 |