Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 452 | OR |
Y | 103T00000X | Psychologist | 452 | OR |
NPI | 1013055623 |
---|---|
Provider Name | Dr. Michael Francis O'connell |
First Address | Medford, OR 97504-6124 |
Second Address | Medford, OR 97504-6124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2007 |
Last Update Date | 02/06/2011 |