Provider Demographics
NPI:1861633505
Name:DONOVAN, GAIL ANN (OTR)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:ANN
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8569 STOUT AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1394
Mailing Address - Country:US
Mailing Address - Phone:734-675-9027
Mailing Address - Fax:734-782-7376
Practice Address - Street 1:560 FIFTH ST NW
Practice Address - Street 2:SUITE 404
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-5219
Practice Address - Country:US
Practice Address - Phone:616-356-5000
Practice Address - Fax:616-356-5001
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000554225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist