MEDICARE: MS. JANICE LEIGH DONNELL MS, OT/L

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	5185	NC

General Provider Information

NPI Number	:	1174522858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANICE LEIGH DONNELL MS, OT/L

Provider Business Mailing Address
First Line	:	307 ALLEN MOUNTAIN DR
Second Line	:
City	:	BLACK MOUNTAIN
State	:	NC
Zip	:	28711-2605
Country	:	US
Telephone Number	:	828-669-2919
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 ALLEN MOUNTAIN DR
Second Line	:
City	:	BLACK MOUNTAIN
State	:	NC
Zip	:	28711-2605
Country	:	US
Telephone Number	:	828-669-2919
Fax Number	:

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/08/2007

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