Provider Demographics
NPI:1235380106
Name:PERRY, DONNA LOUISE (COTA/L)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LOUISE
Last Name:PERRY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 EDGEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-1314
Mailing Address - Country:US
Mailing Address - Phone:610-826-4553
Mailing Address - Fax:
Practice Address - Street 1:303 EDGEMONT AVE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1314
Practice Address - Country:US
Practice Address - Phone:610-826-4553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0P000208L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant