Provider Demographics
NPI:1265602270
Name:JEWETT, DONNA CHAMBERLAND (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:CHAMBERLAND
Last Name:JEWETT
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 1:400 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4923
Mailing Address - Country:US
Mailing Address - Phone:860-584-3400
Mailing Address - Fax:560-589-8686
Practice Address - Street 1:400 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4923
Practice Address - Country:US
Practice Address - Phone:860-584-3400
Practice Address - Fax:560-589-8686
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000041224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant