Provider Demographics
NPI:1043452212
Name:DONDZILA, THERESA (OTR/L)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:DONDZILA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:
Other - Last Name:DONDZILA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:2385 HEATHER DRIVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2701
Mailing Address - Country:US
Mailing Address - Phone:404-966-0276
Mailing Address - Fax:678-301-4226
Practice Address - Street 1:1510 OAK GROVE RD
Practice Address - Street 2:STE. 2
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2701
Practice Address - Country:US
Practice Address - Phone:404-236-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2413225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist