Provider Demographics
NPI:1124256177
Name:UTTON, DONNA DWYER (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:DWYER
Last Name:UTTON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 SARDOU RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-7816
Mailing Address - Country:US
Mailing Address - Phone:910-793-1942
Mailing Address - Fax:
Practice Address - Street 1:5230 SARDOU RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-7816
Practice Address - Country:US
Practice Address - Phone:910-793-1942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5195224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant