Provider Demographics
NPI:1952662512
Name:GRAHAM, DONNA REID (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:REID
Last Name:GRAHAM
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 1:4355 BARWICK RD
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643-4805
Mailing Address - Country:US
Mailing Address - Phone:229-977-1590
Mailing Address - Fax:229-224-5002
Practice Address - Street 1:4355 BARWICK RD
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-4805
Practice Address - Country:US
Practice Address - Phone:229-977-1590
Practice Address - Fax:229-224-5002
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA000479224Z00000X
FLOTA12259224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant