Provider Demographics
NPI:1033281266
Name:BANISTER, DONNA (OTR)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BANISTER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2104
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95021-2104
Mailing Address - Country:US
Mailing Address - Phone:408-712-4669
Mailing Address - Fax:408-842-0158
Practice Address - Street 1:190 1ST ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5129
Practice Address - Country:US
Practice Address - Phone:408-712-4669
Practice Address - Fax:408-842-0158
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3589225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand