Provider Demographics
NPI:1336380229
Name:DETTMANN, DONNA LYNN (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:DETTMANN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-9124
Mailing Address - Country:US
Mailing Address - Phone:605-878-1032
Mailing Address - Fax:
Practice Address - Street 1:1112 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-9124
Practice Address - Country:US
Practice Address - Phone:605-878-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD408225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist