Provider Demographics
NPI:1861819930
Name:DONALDSON, CAROL WILSON (LMT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:WILSON
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 SECOR RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1539
Mailing Address - Country:US
Mailing Address - Phone:419-537-9382
Mailing Address - Fax:734-856-8494
Practice Address - Street 1:3550 SECOR RD
Practice Address - Street 2:SUITE 202
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1539
Practice Address - Country:US
Practice Address - Phone:419-537-9382
Practice Address - Fax:734-856-8494
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7268225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7268OtherOHIO STATE MEDICAL BOARD