Provider Demographics
NPI:1386206456
Name:MCDONAGH, DENNIS MATTHEW (COTA)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:MATTHEW
Last Name:MCDONAGH
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3063
Mailing Address - Country:US
Mailing Address - Phone:941-730-2772
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:1450 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3063
Practice Address - Country:US
Practice Address - Phone:941-730-2772
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13860224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant