Provider Demographics
NPI:1790962520
Name:DONNELLY, MICHELE (COTA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4217
Mailing Address - Country:US
Mailing Address - Phone:757-873-2932
Mailing Address - Fax:
Practice Address - Street 1:729 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 4C
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4217
Practice Address - Country:US
Practice Address - Phone:757-873-2932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant