Healthcare Provider Details

I. General information

NPI: 1023207719
Provider Name (Legal Business Name): DONNA WONG RICKARDS MS,OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12145 BRIDGETON SQ
BRIDGETON MO
63044-2616
US

IV. Provider business mailing address

12145 BRIDGETON SQ
BRIDGETON MO
63044-2616
US

V. Phone/Fax

Practice location:
  • Phone: 207-650-4340
  • Fax:
Mailing address:
  • Phone: 207-650-4340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number9479
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT01087
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number2009012932
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: