Healthcare Provider Details

I. General information

NPI: 1922063130
Provider Name (Legal Business Name): DONNA HUMPHRIES HASBROUCK MS,OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S OLIVE AVE STE 106
WEST PALM BEACH FL
33401-6127
US

IV. Provider business mailing address

801 S OLIVE AVE STE 106
WEST PALM BCH FL
33401-6127
US

V. Phone/Fax

Practice location:
  • Phone: 561-461-5343
  • Fax: 561-530-2026
Mailing address:
  • Phone: 561-461-5343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT0008087
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: