Provider Demographics
NPI:1871759324
Name:MCDONALD, MAUREEN O (COTA)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:O
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:L
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8104 SPRINGLAKE CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2618
Mailing Address - Country:US
Mailing Address - Phone:502-339-1660
Mailing Address - Fax:
Practice Address - Street 1:8104 SPRINGLAKE CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2618
Practice Address - Country:US
Practice Address - Phone:502-339-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32000333A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant