Provider Demographics
NPI:1295926889
Name:EVANS, DONNA (COTA)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2704 W KILAREA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6378
Mailing Address - Country:US
Mailing Address - Phone:480-413-0642
Mailing Address - Fax:
Practice Address - Street 1:2704 W KILAREA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6378
Practice Address - Country:US
Practice Address - Phone:480-413-0642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1570224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant