Provider Demographics
NPI:1114068434
Name:CHILDS, DONNA LYNN (OTR)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LYNN
Last Name:CHILDS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2332 HARRISON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3234
Mailing Address - Country:US
Mailing Address - Phone:707-445-8080
Mailing Address - Fax:707-445-8088
Practice Address - Street 1:475 MEMORY LN
Practice Address - Street 2:
Practice Address - City:BOULDER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95006-9130
Practice Address - Country:US
Practice Address - Phone:707-445-8080
Practice Address - Fax:707-445-8088
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1013690225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA271 82 7541OtherSS#
CAOT0053780OtherBLUE SHIELD
CA1013690OtherOTR LICENSE
CA362098200OtherFEDERAL WORKERS' COMP