Provider Demographics
NPI:1619552973
Name:DONOHUE, SIOBHAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 HURLEY AVE APT 6F
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6835
Mailing Address - Country:US
Mailing Address - Phone:585-478-2005
Mailing Address - Fax:
Practice Address - Street 1:4885 U.S. 9
Practice Address - Street 2:
Practice Address - City:STAATSBURG
Practice Address - State:NY
Practice Address - Zip Code:14424-1442
Practice Address - Country:US
Practice Address - Phone:845-889-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025189225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist