Provider Demographics
NPI:1437314689
Name:CORLEY, DONNA MASSEY (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MASSEY
Last Name:CORLEY
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 1:127 W MONTCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-4653
Mailing Address - Country:US
Mailing Address - Phone:864-430-1831
Mailing Address - Fax:
Practice Address - Street 1:127 W MONTCLAIR AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4653
Practice Address - Country:US
Practice Address - Phone:864-430-1831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-26
Last Update Date:2008-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC448225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist