Provider Demographics
NPI:1629361498
Name:DONAHEY, KIM SUZANNE
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:SUZANNE
Last Name:DONAHEY
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 1:941 E 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3015
Mailing Address - Country:US
Mailing Address - Phone:541-954-8484
Mailing Address - Fax:
Practice Address - Street 1:941 E 22ND AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3015
Practice Address - Country:US
Practice Address - Phone:541-954-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7408225700000X
HI11385225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist