Provider Demographics
NPI:1629540067
Name:DONES, WILFREDO LAZARUS (OTR/L, MSOT)
Entity Type:Individual
Prefix:MR
First Name:WILFREDO
Middle Name:LAZARUS
Last Name:DONES
Suffix:
Gender:M
Credentials:OTR/L, MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 BEAVER DR
Mailing Address - Street 2:
Mailing Address - City:ALBRIGHTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18210-3844
Mailing Address - Country:US
Mailing Address - Phone:570-972-7625
Mailing Address - Fax:
Practice Address - Street 1:701 SLATE BELT BLVD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-9341
Practice Address - Country:US
Practice Address - Phone:610-588-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-25
Last Update Date:2018-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC015762225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist