Provider Demographics
NPI:1295952042
Name:DONOVAN, JACLYN KAYLOR (MBA, MS, ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:JACLYN
Middle Name:KAYLOR
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MBA, MS, ATC, LAT
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Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:VEREEN REHABILITATION CENTER
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31776-0040
Mailing Address - Country:US
Mailing Address - Phone:229-890-3553
Mailing Address - Fax:229-890-5331
Practice Address - Street 1:3100 VETERANS PKWY S
Practice Address - Street 2:VEREEN REHABILITATION CENTER
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31788-9400
Practice Address - Country:US
Practice Address - Phone:229-890-3553
Practice Address - Fax:229-890-5331
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2014-04-16
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Provider Licenses
StateLicense IDTaxonomies
GAAT0009352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer