Provider Demographics
NPI:1689662934
Name:GILBERT, DONNA MARIE (OTRL CHT)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
Last Name:GILBERT
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:GILBERT-REISCHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:690 N COFCO CENTER CT
Mailing Address - Street 2:STE 260
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6462
Mailing Address - Country:US
Mailing Address - Phone:602-279-6905
Mailing Address - Fax:602-279-6934
Practice Address - Street 1:1805 N 91ST AVE
Practice Address - Street 2:STE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4051
Practice Address - Country:US
Practice Address - Phone:623-907-0828
Practice Address - Fax:888-445-4263
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1071225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ694986Medicaid
AZZ113264OtherMEDICARE GROUP
AZ694986Medicaid
AZZ113264OtherMEDICARE GROUP
P61217Medicare UPIN
AZ70648Medicare ID - Type Unspecified
AZ1831211143Medicare NSC
AZ1629137997Medicare NSC
AZ1124187489Medicare NSC