MEDICARE: MICHELLE DONDERO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist
2	225X00000X	Occupational Therapist	OT24525

General Provider Information

NPI Number	:	1174339113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE DONDERO

Provider Business Mailing Address
First Line	:	9845 CITADEL LN UNIT 202N
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-4688
Country	:	US
Telephone Number	:	973-219-7461
Fax Number	:

Provider Business Practice Location Address
First Line	:	1715 HERITAGE TRL UNIT 2023
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34112-8715
Country	:	US
Telephone Number	:	239-558-2016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2024
Last Update Date	:	12/04/2024

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Directions to “ MICHELLE DONDERO ” Practice Location

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