=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861633505
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GAIL ANN DONOVAN OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2009
-----------------------------------------------------
Last Update Date | 03/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 560 FIFTH ST NW SUITE 404
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49504-5219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-356-5000
-----------------------------------------------------
Fax | 616-356-5001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8569 STOUT AVE
-----------------------------------------------------
City | GROSSE ILE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48138-1394
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-675-9027
-----------------------------------------------------
Fax | 734-782-7376
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 5201000554
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------