Provider Demographics
NPI:1619180270
Name:MACDONALD, DOUGLAS P (OTR)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:P
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LITTLEWORTH RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4313
Mailing Address - Country:US
Mailing Address - Phone:603-749-6103
Mailing Address - Fax:603-749-6103
Practice Address - Street 1:17 LITTLEWORTH RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4313
Practice Address - Country:US
Practice Address - Phone:603-749-6103
Practice Address - Fax:603-749-6103
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1335225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist