Provider Demographics
NPI:1013077502
Name:MCCALL, DONNA STATLER (MS OTRL)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:STATLER
Last Name:MCCALL
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FRONT STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850
Mailing Address - Country:US
Mailing Address - Phone:607-754-2313
Mailing Address - Fax:607-754-6926
Practice Address - Street 1:200 FRONT STREET
Practice Address - Street 2:SUITE C
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850
Practice Address - Country:US
Practice Address - Phone:607-754-2313
Practice Address - Fax:607-754-6926
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007751225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC3686Medicare ID - Type Unspecified