Provider Demographics
NPI:1366728800
Name:DONOVAN, KAREN LEE (COTA)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LEE
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 WHITE RD
Mailing Address - Street 2:
Mailing Address - City:GLEN SPEY
Mailing Address - State:NY
Mailing Address - Zip Code:12737-5632
Mailing Address - Country:US
Mailing Address - Phone:845-988-0335
Mailing Address - Fax:
Practice Address - Street 1:173 WHITE RD
Practice Address - Street 2:
Practice Address - City:GLEN SPEY
Practice Address - State:NY
Practice Address - Zip Code:12737-5632
Practice Address - Country:US
Practice Address - Phone:845-988-0335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
002591-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant