Provider Demographics
NPI:1699236067
Name:DONAHUE, CORY LOGAN (COTA)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:LOGAN
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 ARN AVE
Mailing Address - Street 2:
Mailing Address - City:TILTONSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43963-1102
Mailing Address - Country:US
Mailing Address - Phone:740-381-5105
Mailing Address - Fax:
Practice Address - Street 1:300 CENTER AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8243
Practice Address - Country:US
Practice Address - Phone:724-852-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP008892224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant