Provider Demographics
NPI:1548342652
Name:ODONNELL, NANCY B (OTRL BC AC SF)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:B
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:OTRL BC AC SF
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:C
Other - Last Name:BRUDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 S BROOK FOREST ROAD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037
Mailing Address - Country:US
Mailing Address - Phone:316-788-4546
Mailing Address - Fax:
Practice Address - Street 1:712 N MONROE
Practice Address - Street 2:SEDWICK HEALTH CARE CENTER
Practice Address - City:SEDGWICK
Practice Address - State:KS
Practice Address - Zip Code:67135
Practice Address - Country:US
Practice Address - Phone:316-772-5185
Practice Address - Fax:316-772-0396
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1700244225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist