Provider Demographics
NPI:1790772077
Name:PEPE, DONNA W (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:W
Last Name:PEPE
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WEST MAIN ST
Mailing Address - Street 2:NOSS
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3119
Mailing Address - Country:US
Mailing Address - Phone:203-755-7115
Mailing Address - Fax:203-755-7067
Practice Address - Street 1:1320 WEST MAIN ST
Practice Address - Street 2:NOSS
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3119
Practice Address - Country:US
Practice Address - Phone:203-755-7115
Practice Address - Fax:203-755-7067
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000761225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400282479Medicare PIN