Provider Demographics
NPI:1316344245
Name:ROME-MARTIN, DONNIELLE LAUREN (OTR/L)
Entity type:Individual
Prefix:MS
First Name:DONNIELLE
Middle Name:LAUREN
Last Name:ROME-MARTIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 N TRADD ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-5239
Mailing Address - Country:US
Mailing Address - Phone:516-455-9860
Mailing Address - Fax:
Practice Address - Street 1:129 N TRADD ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5239
Practice Address - Country:US
Practice Address - Phone:516-455-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018414-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist