Provider Demographics
NPI:1023310950
Name:RYAN, DONNA JEANNE
Entity type:Individual
Prefix:MISS
First Name:DONNA
Middle Name:JEANNE
Last Name:RYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 411
Mailing Address - Street 2:154 OLD WORCESTER ROAD
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507
Mailing Address - Country:US
Mailing Address - Phone:508-248-7008
Mailing Address - Fax:
Practice Address - Street 1:15 SOUTH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749
Practice Address - Country:US
Practice Address - Phone:508-298-1640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist