Provider Demographics
NPI:1104904119
Name:REVERA, DONNA (OTR/L)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:REVERA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11183 NW 5TH MNR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7937
Mailing Address - Country:US
Mailing Address - Phone:954-914-0793
Mailing Address - Fax:
Practice Address - Street 1:11183 NW 5TH MNR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7937
Practice Address - Country:US
Practice Address - Phone:954-914-0793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 3597225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist