Provider Demographics
NPI:1497093991
Name:DONOVAN, REBEKAH LYNN (DI)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:LYNN
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4490 BROOKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:KY
Mailing Address - Zip Code:40109-5003
Mailing Address - Country:US
Mailing Address - Phone:502-648-4093
Mailing Address - Fax:502-589-2409
Practice Address - Street 1:4490 BROOKS HILL RD
Practice Address - Street 2:
Practice Address - City:BROOKS
Practice Address - State:KY
Practice Address - Zip Code:40109-5003
Practice Address - Country:US
Practice Address - Phone:502-648-4093
Practice Address - Fax:502-589-2409
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY201133778222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist