Provider Demographics
NPI:1013152917
Name:DONOVAN, ANDREA B (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:B
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ANN ROSE STREET
Mailing Address - Street 2:
Mailing Address - City:MASSAPQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758
Mailing Address - Country:US
Mailing Address - Phone:516-795-7120
Mailing Address - Fax:
Practice Address - Street 1:7 ANN ROSE ST
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-3707
Practice Address - Country:US
Practice Address - Phone:516-795-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01194-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist