Provider Demographics
NPI:1336498575
Name:HERMISON, DONNA B
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:B
Last Name:HERMISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 CHURCHILL HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1346
Mailing Address - Country:US
Mailing Address - Phone:330-759-5904
Mailing Address - Fax:330-759-8709
Practice Address - Street 1:1325 CHURCHILL HUBBARD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1346
Practice Address - Country:US
Practice Address - Phone:330-759-5904
Practice Address - Fax:330-759-8709
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006782225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH366731Medicare Oscar/Certification