Provider Demographics
NPI:1538281720
Name:KOTILAINEN, DONNA A (PT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:A
Last Name:KOTILAINEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DEE
Other - Middle Name:
Other - Last Name:KOTILAINEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2126 WISCONSIN ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4750
Mailing Address - Country:US
Mailing Address - Phone:505-385-3975
Mailing Address - Fax:
Practice Address - Street 1:4308 CARLISLE BLVD NE
Practice Address - Street 2:SUITE 205
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4856
Practice Address - Country:US
Practice Address - Phone:505-828-0232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM319171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor