Provider Demographics
NPI:1649335845
Name:REARICK, DONNA LYNN (COTAL)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LYNN
Last Name:REARICK
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WATSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17777-1013
Mailing Address - Country:US
Mailing Address - Phone:570-419-6547
Mailing Address - Fax:
Practice Address - Street 1:889 FAIRGROUND RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-8808
Practice Address - Country:US
Practice Address - Phone:570-524-2221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP005820224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant