Provider Demographics
NPI:1114304581
Name:DONVAN, KINDRA (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:KINDRA
Middle Name:
Last Name:DONVAN
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5658
Mailing Address - Country:US
Mailing Address - Phone:701-572-6757
Mailing Address - Fax:
Practice Address - Street 1:222 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5658
Practice Address - Country:US
Practice Address - Phone:701-572-6757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1402225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist