Provider Demographics
NPI:1770054272
Name:INTRAVAIA-HIGGINS, DONNA ROSE (OTRL)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:ROSE
Last Name:INTRAVAIA-HIGGINS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WENTWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-4937
Mailing Address - Country:US
Mailing Address - Phone:978-761-2545
Mailing Address - Fax:
Practice Address - Street 1:500 WENTWORTH AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-4937
Practice Address - Country:US
Practice Address - Phone:978-761-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-09
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3550225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist