MEDICARE: DONNA JEAN NOTHDURFT MS, OTR, CHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT4842	FL

General Provider Information

NPI Number	:	1881639086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA JEAN NOTHDURFT MS, OTR, CHT

Provider Business Mailing Address
First Line	:	1400 E LAKE DR
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-8108
Country	:	US
Telephone Number	:	727-945-1867
Fax Number	:

Provider Business Practice Location Address
First Line	:	3488 E LAKE RD
Second Line	:	SUITE 302
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2404
Country	:	US
Telephone Number	:	727-786-1996
Fax Number	:	727-789-2111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/08/2007

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