Provider Demographics
NPI:1376930743
Name:COSTA, DONNA MARIE (DHS, OTR/L)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:COSTA
Suffix:
Gender:F
Credentials:DHS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 AMERICAN PACIFIC DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-8800
Mailing Address - Country:US
Mailing Address - Phone:702-777-3220
Mailing Address - Fax:
Practice Address - Street 1:874 AMERICAN PACIFIC DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-8800
Practice Address - Country:US
Practice Address - Phone:702-777-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13-0323225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist