Provider Demographics
NPI:1043959901
Name:DONNELLY, MARGARET NICOLE
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:NICOLE
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 MOUNTAIN PEAK CT
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:MO
Mailing Address - Zip Code:63069-6609
Mailing Address - Country:US
Mailing Address - Phone:636-575-9633
Mailing Address - Fax:
Practice Address - Street 1:3407 S JEFFERSON AVE STE 145
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3119
Practice Address - Country:US
Practice Address - Phone:314-833-8848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2022005471OtherOT LICENSE