Provider Demographics
NPI:1669640272
Name:CARRON, DONNA L (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:L
Last Name:CARRON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 CHARLSIE ELYN CT
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:TN
Mailing Address - Zip Code:37010-9176
Mailing Address - Country:US
Mailing Address - Phone:931-358-2568
Mailing Address - Fax:
Practice Address - Street 1:198 FARMER RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-7010
Practice Address - Country:US
Practice Address - Phone:931-358-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-16
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5035314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility