Provider Demographics
NPI:1912103193
Name:DILLON, ANN DONOGHUE (OTL)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:DONOGHUE
Last Name:DILLON
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WENDELL DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03833-6201
Mailing Address - Country:US
Mailing Address - Phone:603-778-1093
Mailing Address - Fax:
Practice Address - Street 1:55 COLLEGE RD
Practice Address - Street 2:103 PETTEE HALL
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-2621
Practice Address - Country:US
Practice Address - Phone:603-862-0561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0027OtherOCCUPATIONAL THERAPIST- P