Basic Information
| Provider Information | |||||||||
| NPI: | 1922062157 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'DONNELL | ||||||||
| FirstName: | CASEY | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 LONGWATER DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817924136 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 POND PARK RD STE 303 | ||||||||
| Address2: | |||||||||
| City: | HINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020434354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7816242525 | ||||||||
| FaxNumber: | 7817416297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | OS11404 | FL | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 208100000X | 25MB07680200 | NJ | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | OS013626 | PA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2081P2900X | DO00614 | RI | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 208VP0014X | DO00614 | RI | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208100000X | 234536 | MA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 019522600 | 05 | FL | MEDICAID |