Provider Demographics
NPI:1386968493
Name:DONNELLY, SHARRON NICOLE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:SHARRON
Middle Name:NICOLE
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7144
Mailing Address - Country:US
Mailing Address - Phone:971-207-6550
Mailing Address - Fax:503-245-6013
Practice Address - Street 1:11320 NE 49TH ST STE 208
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-6547
Practice Address - Country:US
Practice Address - Phone:971-207-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0T00002953225XP0200X
OR1021785225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics