Provider Demographics
NPI:1205079472
Name:CASAVANT, DONNA LEE
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LEE
Last Name:CASAVANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:LEE
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 ICHABOD LN
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-2004
Mailing Address - Country:US
Mailing Address - Phone:207-862-5184
Mailing Address - Fax:
Practice Address - Street 1:11 ICHABOD LN
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444-2004
Practice Address - Country:US
Practice Address - Phone:207-862-5184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME198710000Medicaid