Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 34003222 | OH |
NPI | 1306810635 |
---|---|
Provider Name | Dr. Judith Ann O'connell |
First Address | Beavercreek, OH 45431-3820 |
Second Address | Beavercreek, OH 45431-3820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 22/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0509524 | (05) | OH |
E00678 | (02) | OH |