Provider Demographics
NPI:1669634135
Name:MCMILLAN, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7733 FORSYTH BLVD
Mailing Address - Street 2:#2200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1817
Mailing Address - Country:US
Mailing Address - Phone:815-432-2934
Mailing Address - Fax:815-432-2934
Practice Address - Street 1:7733 FORSYTH BLVD
Practice Address - Street 2:#2200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1817
Practice Address - Country:US
Practice Address - Phone:815-432-2934
Practice Address - Fax:815-432-2934
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057-002241224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant