Provider Demographics
NPI:1669860417
Name:AVERETT, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:AVERETT
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 1:3003 ADOBE FALLS DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386
Mailing Address - Country:US
Mailing Address - Phone:830-931-4114
Mailing Address - Fax:
Practice Address - Street 1:30003 ADOBE FALLS DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-3053
Practice Address - Country:US
Practice Address - Phone:830-931-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106416225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist