Provider Demographics
NPI:1457409252
Name:DONICA, DENISE K (OT)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:K
Last Name:DONICA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 DUNBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-5820
Mailing Address - Country:US
Mailing Address - Phone:252-756-6646
Mailing Address - Fax:
Practice Address - Street 1:1100 DUNBROOK DR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-5820
Practice Address - Country:US
Practice Address - Phone:252-756-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003248A225X00000X
NC6894225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist