Healthcare Provider Details

I. General information

NPI: 1093878522
Provider Name (Legal Business Name): JOHN- PAUL DONOVAN CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1274 CONGRESS ST
PORTLAND ME
04102-2111
US

IV. Provider business mailing address

1274 CONGRESS ST
PORTLAND ME
04102-2111
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-1002
  • Fax: 207-774-9002
Mailing address:
  • Phone: 207-774-1002
  • Fax: 207-774-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: