Provider Demographics
NPI:1265568711
Name:BRINK, DONNA MARIE (OTR/L OTD)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:BRINK
Suffix:
Gender:F
Credentials:OTR/L OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20770 GROVELINE CT
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3133
Mailing Address - Country:US
Mailing Address - Phone:607-761-3487
Mailing Address - Fax:
Practice Address - Street 1:HEALTH PLANNING COUNCIL OF SOUTHWEST FLORIDA
Practice Address - Street 2:8961 DANIELS CENTER DRIVE #401
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-443-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15423222Q00000X, 225X00000X
PA002459225X00000X
NY005253225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012795000001Medicaid
PA1020348150001Medicaid
FL015696500Medicaid