1780620187 NPI number — MRS. AIMEE ELIZABETH MACDONELL I OTR/L

Table of content: MRS. AIMEE ELIZABETH MACDONELL I OTR/L (NPI 1780620187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780620187 NPI number — MRS. AIMEE ELIZABETH MACDONELL I OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACDONELL
Provider First Name:
AIMEE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
I
Provider Credential Text:
OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PADDEN
Provider Other First Name:
AIMEE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR /L
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1780620187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 SW INDUSTRIAL WAY
Provider Second Line Business Mailing Address:
STE 3
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97702-1093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-585-2529
Provider Business Mailing Address Fax Number:
541-585-2536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1303 NE CUSHING DR
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97701-3891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-382-7875
Provider Business Practice Location Address Fax Number:
541-382-2181
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  1005205 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X , with the licence number: OT00002501 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 230787 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com