Basic Information
| Provider Information | |||||||||
| NPI: | 1386634640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANN | ||||||||
| FirstName: | DONNA | ||||||||
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| Credential: | OTR L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 W 5TH AVE | ||||||||
| Address2: | STE 304 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096242353 | ||||||||
| FaxNumber: | 5096242501 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 W 5TH AVE | ||||||||
| Address2: | STE 304 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096242353 | ||||||||
| FaxNumber: | 5096242501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 08/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT 00000447 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XE1200X | OT00000447 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Ergonomics | 225XH1200X | OT00000447 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 8341281 | 05 | WA | MEDICAID |