Provider Demographics
NPI:1306180856
Name:DONAHUE, MELISSA (COTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:MCCOMBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:8211 LAGERFELD DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34637-3207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:602 VONDERBURG DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5900
Practice Address - Country:US
Practice Address - Phone:813-653-1149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA10985224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTA10985OtherDOH LICENSE