Provider Demographics
NPI:1447427653
Name:GIFFORD, DONNA M (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:GIFFORD
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 1:8127 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2140
Mailing Address - Country:US
Mailing Address - Phone:414-763-7415
Mailing Address - Fax:
Practice Address - Street 1:1126 S 70TH ST
Practice Address - Street 2:SUITE SOUTH. 308B
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-3151
Practice Address - Country:US
Practice Address - Phone:414-456-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2872026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist