Provider Demographics
NPI:1902026925
Name:O'ROURKE, DONNA (OTR)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:O'ROURKE
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 1:56 LODGE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3436
Mailing Address - Country:US
Mailing Address - Phone:516-735-7778
Mailing Address - Fax:516-735-4159
Practice Address - Street 1:2920 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1402
Practice Address - Country:US
Practice Address - Phone:516-735-7778
Practice Address - Fax:516-735-4159
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004946-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004946OtherLIC NUMBER