Individual
MS. KELLY O'DONNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1 MOUNT MCKINLEY AVE, FARMINGVILLE, NY 11738-2107
(631) 766-4235
Mailing address
386 ERIE ST, HOLBROOK, NY 11741-2927
(631) 766-4235
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
311363-1
NY
225700000X
Massage Therapist
Primary
012679-1
NY
Other
Enumeration date
02/27/2020
Last updated
02/27/2020
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