Provider Demographics
NPI:1356502819
Name:WOOSTER, DONNA A (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:A
Last Name:WOOSTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28003 OAKACHOY LOOP
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-6345
Mailing Address - Country:US
Mailing Address - Phone:251-751-6972
Mailing Address - Fax:
Practice Address - Street 1:28003 OAKACHOY LOOP
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-6345
Practice Address - Country:US
Practice Address - Phone:251-751-6972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0909171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor