Mikenna Marie O'Donnell, OTR/L
Individual provider Active NPI Occupational Therapist · Baker, MT
NPI 1033676630 · NPPES record last updated Mar 1, 2019
Key facts
- NPI
- 1033676630
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OTP-OT-LIC-6625 (MT)
- Practice address
- 202 S 4TH St W
Baker, MT 59313-9156 - Phone
- (406) 778-3331
- Fax
- (406) 778-5163
- NPI assigned
- Mar 1, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230705000582 | MT | Practitioner - Occupational Therapist in Private Practice | 7113386475 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTP-OT-LIC-6625 | MT | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fallon Medical Complex Inc | Current | Accepting new patients |
Locations
710 Drake St
Wibaux, MT 59353
Phone (406) 778-2833
Interoperability endpoints
- https://fhir-usa.unify.chbase.com/org/fallmed-8378dd67
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OTP-OT-LIC-6625 | MT | Yes |
Addresses
Primary practice location
202 S 4TH St W
Baker, MT 59313-9156
Mailing address
PO Box 1015
Baker, MT 59313-1015
Phone (406) 702-5026
Other providers in Baker, MT
- Fallon Medical Complex, Inc
- Gerald Gamrath
- Carrie Jo Haar
- Amber Elena Hurley
- Tylyn Loudermilk
- Todd Overton
- Eric S Sonsalla
- Brian Michael Sullivan
- Superior Care Villa
- Victoria J Susa
All providers in Baker, MT · Occupational Therapist in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.