Healthcare Provider Details

I. General information

NPI: 1659697795
Provider Name (Legal Business Name): MS. DONNA ANN GURSCHKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7502 SAINT CECELIA ST
AUSTIN TX
78757-1213
US

IV. Provider business mailing address

7502 SAINT CECELIA ST
AUSTIN TX
78757-1213
US

V. Phone/Fax

Practice location:
  • Phone: 414-699-6934
  • Fax:
Mailing address:
  • Phone: 414-699-6934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number112663
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number112663
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: