Provider Demographics
NPI:1194888586
Name:DONOVAN, CAROL DEYOUB (OTR)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:DEYOUB
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20162 FOXBORO ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7914
Mailing Address - Country:US
Mailing Address - Phone:734-479-5244
Mailing Address - Fax:734-246-6071
Practice Address - Street 1:20162 FOXBORO ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7914
Practice Address - Country:US
Practice Address - Phone:734-479-5244
Practice Address - Fax:734-246-6071
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000649225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist