Provider Demographics
NPI:1386634640
Name:MANN, DONNA (OTR L)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MANN
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 1:601 W 5TH AVE
Mailing Address - Street 2:STE 304
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2705
Mailing Address - Country:US
Mailing Address - Phone:509-624-2353
Mailing Address - Fax:509-624-2501
Practice Address - Street 1:601 W 5TH AVE
Practice Address - Street 2:STE 304
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2705
Practice Address - Country:US
Practice Address - Phone:509-624-2353
Practice Address - Fax:509-624-2501
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 00000447225X00000X
WAOT00000447225XE1200X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8341281Medicaid
WA8341281Medicaid