Provider Demographics
NPI:1972238004
Name:LEWELLEN, DONNA (COTA/L)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:LEWELLEN
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 1:11391 N CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:IN
Mailing Address - Zip Code:46157-8104
Mailing Address - Country:US
Mailing Address - Phone:317-997-9067
Mailing Address - Fax:
Practice Address - Street 1:118 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3323
Practice Address - Country:US
Practice Address - Phone:317-843-4590
Practice Address - Fax:317-200-3966
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002274A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant