Provider Demographics
NPI:1699922815
Name:DONNELLAN, JOAN M (MS OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:M
Last Name:DONNELLAN
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 1:13 TOWER HILL RD
Mailing Address - Street 2:P.O. BOX 110
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-1030
Mailing Address - Country:US
Mailing Address - Phone:631-744-3343
Mailing Address - Fax:
Practice Address - Street 1:240 MASTIC BEACH RD
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-1028
Practice Address - Country:US
Practice Address - Phone:631-874-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013449-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist