Provider Demographics
NPI:1265180517
Name:OMALLEY, DONNA BETH (COTA/L)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:BETH
Last Name:OMALLEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:BETH
Other - Last Name:CONNORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:44 RIVER LN
Mailing Address - Street 2:
Mailing Address - City:MARBLE
Mailing Address - State:NC
Mailing Address - Zip Code:28905-8335
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:551 KENT ST
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:NC
Practice Address - Zip Code:28901-8088
Practice Address - Country:US
Practice Address - Phone:828-321-3075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant