Provider Demographics
NPI:1518084748
Name:TICKLE, DONNA KAY (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:KAY
Last Name:TICKLE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 SUMMIT HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4480
Mailing Address - Country:US
Mailing Address - Phone:336-794-0585
Mailing Address - Fax:
Practice Address - Street 1:901 BETHESDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3015
Practice Address - Country:US
Practice Address - Phone:336-768-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2617225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist