Provider Demographics
NPI:1558933838
Name:SMITH, DONNA DODSON
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:DODSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8733 W YULEE DRIVE
Mailing Address - Street 2:LEGACY
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34448
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8733 W YULEE DRIVE
Practice Address - Street 2:LEGACY
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34448-3444
Practice Address - Country:US
Practice Address - Phone:352-621-8017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5593224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant