Provider Demographics
NPI:1720270622
Name:GARDNER, DONNA SHADRIX (OT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:SHADRIX
Last Name:GARDNER
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 1:1525 GREENBRIER DEAR RD
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-6705
Mailing Address - Country:US
Mailing Address - Phone:256-835-9099
Mailing Address - Fax:256-835-6077
Practice Address - Street 1:1525 GREENBRIER DEAR RD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-6705
Practice Address - Country:US
Practice Address - Phone:256-835-9099
Practice Address - Fax:256-835-6077
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0210225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist