Provider Demographics
NPI:1730343088
Name:DONCOV, ELIJAH N (OTR)
Entity type:Individual
Prefix:MR
First Name:ELIJAH
Middle Name:N
Last Name:DONCOV
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 W BELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-2754
Mailing Address - Country:US
Mailing Address - Phone:979-224-6656
Mailing Address - Fax:
Practice Address - Street 1:700 DYER ST
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2208
Practice Address - Country:US
Practice Address - Phone:512-446-2548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108475225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist