Provider Demographics
NPI:1811389349
Name:DONOVAN, LAURA ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:DONOVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:101 E REDLANDS BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4724
Mailing Address - Country:US
Mailing Address - Phone:909-793-1078
Mailing Address - Fax:909-335-7330
Practice Address - Street 1:101 E REDLANDS BLVD STE 215
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4724
Practice Address - Country:US
Practice Address - Phone:909-793-1078
Practice Address - Fax:909-335-7330
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT7864225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics