Healthcare Provider Details

I. General information

NPI: 1194888586
Provider Name (Legal Business Name): CAROL DEYOUB DONOVAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20162 FOXBORO ST
RIVERVIEW MI
48193-7914
US

IV. Provider business mailing address

20162 FOXBORO ST
RIVERVIEW MI
48193-7914
US

V. Phone/Fax

Practice location:
  • Phone: 734-479-5244
  • Fax: 734-246-6071
Mailing address:
  • Phone: 734-479-5244
  • Fax: 734-246-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201000649
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: