Provider Demographics
NPI:1871837146
Name:MASHORE, DONNA WYCHE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:WYCHE
Last Name:MASHORE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4671 FOUR SEASONS TER
Mailing Address - Street 2:UNIT D
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9204
Mailing Address - Country:US
Mailing Address - Phone:804-677-9226
Mailing Address - Fax:
Practice Address - Street 1:4671 FOUR SEASONS TER
Practice Address - Street 2:UNIT D
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-9204
Practice Address - Country:US
Practice Address - Phone:804-677-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000412225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist