Provider Demographics
NPI:1093389066
Name:DONDERSHINE, MARCI LIN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MARCI
Middle Name:LIN
Last Name:DONDERSHINE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 PROMONTORY POINT LN
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7274
Mailing Address - Country:US
Mailing Address - Phone:916-520-4289
Mailing Address - Fax:
Practice Address - Street 1:2151 PROMONTORY POINT LN
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-7274
Practice Address - Country:US
Practice Address - Phone:916-520-4289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14121225XF0002X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14121OtherBOARD OF OCCUPATIONAL THERAPY
310971OtherNATIONAL BOARD OF CERTIFIED OCCUPATIONAL THERAPISTS