Provider Demographics
NPI:1093157570
Name:BUCHANAN, DONNA (OT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BUCHANAN
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 1:1211 S GLOSTER ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6546
Mailing Address - Country:US
Mailing Address - Phone:662-432-1523
Mailing Address - Fax:662-432-1528
Practice Address - Street 1:1211 S GLOSTER ST STE C
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6548
Practice Address - Country:US
Practice Address - Phone:662-432-1523
Practice Address - Fax:662-432-1528
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1252225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist