Provider Demographics
NPI:1104337823
Name:HOLMSTOCK, DONNA MARIE (OT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:HOLMSTOCK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:MARIE
Other - Last Name:MAMMINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:300 ROYAL PALM WAY
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33480-4305
Mailing Address - Country:US
Mailing Address - Phone:561-655-7266
Mailing Address - Fax:561-655-3269
Practice Address - Street 1:300 ROYAL PALM WAY
Practice Address - Street 2:
Practice Address - City:PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33480-4305
Practice Address - Country:US
Practice Address - Phone:561-655-7266
Practice Address - Fax:561-655-7266
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1343225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist