Provider Demographics
NPI:1982984878
Name:PATTISON, DONNA LOUISE
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LOUISE
Last Name:PATTISON
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 1:20600 EUREKA RD
Mailing Address - Street 2:SUITE 707
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-5343
Mailing Address - Country:US
Mailing Address - Phone:313-702-2504
Mailing Address - Fax:313-299-1654
Practice Address - Street 1:20600 EUREKA RD
Practice Address - Street 2:SUITE 707
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5343
Practice Address - Country:US
Practice Address - Phone:313-702-2504
Practice Address - Fax:313-299-1654
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist