Provider Demographics
NPI:1457620395
Name:MCDONALD, DONNA L (COTA/L)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:MCDONALD
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 1:187 OLD ROUTE 304
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6530
Mailing Address - Country:US
Mailing Address - Phone:845-634-7061
Mailing Address - Fax:
Practice Address - Street 1:62 OLD MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2710
Practice Address - Country:US
Practice Address - Phone:845-639-6482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003230-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant