Provider Demographics
NPI:1053445510
Name:SHEALY, DONNA DENISE (LPN, OTR)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:DENISE
Last Name:SHEALY
Suffix:
Gender:F
Credentials:LPN, OTR
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:DENISE
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2432 OLD DOUGLASS RD
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-7799
Mailing Address - Country:US
Mailing Address - Phone:864-923-5339
Mailing Address - Fax:
Practice Address - Street 1:2432 OLD DOUGLASS RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-7799
Practice Address - Country:US
Practice Address - Phone:864-923-5339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2695225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist