Provider Demographics
NPI:1346264157
Name:ROE, DONNA LYNN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LYNN
Last Name:ROE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-2346
Mailing Address - Country:US
Mailing Address - Phone:810-987-7180
Mailing Address - Fax:810-982-5215
Practice Address - Street 1:3135 STRAWBERRY LN
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-2346
Practice Address - Country:US
Practice Address - Phone:810-987-7180
Practice Address - Fax:810-982-5215
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002541225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist