1669455275 NPI number — MRS. JUDY NUTTALL O'DONNELL P.T.

Table of content: MRS. JUDY NUTTALL O'DONNELL P.T. (NPI 1669455275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669455275 NPI number — MRS. JUDY NUTTALL O'DONNELL P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'DONNELL
Provider First Name:
JUDY
Provider Middle Name:
NUTTALL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'DONNELL
Provider Other First Name:
JUDY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1669455275
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CMR 402 BOX 927
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09180-0927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-493-4086
Provider Business Mailing Address Fax Number:
314-493-4236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LRMC, CMR 402, BOX 927
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANDSTUHL
Provider Business Practice Location Address State Name:
GERMANY
Provider Business Practice Location Address Postal Code:
66789
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
314-493-4086
Provider Business Practice Location Address Fax Number:
314-493-4236
Provider Enumeration Date:
11/29/2005

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: 225100000X , with the licence number:  1026458 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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