Provider Demographics
NPI:1326683384
Name:CARUSO, DONNA (OTRL)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:CARUSO
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MILMONT SHORES RD
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-9559
Mailing Address - Country:US
Mailing Address - Phone:803-727-8112
Mailing Address - Fax:
Practice Address - Street 1:2427 OLD LEXINGTON HWY
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-7917
Practice Address - Country:US
Practice Address - Phone:803-319-7723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3801225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist