Provider Demographics
NPI:1134347255
Name:MCGOVERN, DONNA JEAN (OTR)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JEAN
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:JEAN
Other - Last Name:ALLEBORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:613 STANWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2308
Mailing Address - Country:US
Mailing Address - Phone:215-722-5194
Mailing Address - Fax:
Practice Address - Street 1:1104 WELSH ROAD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115
Practice Address - Country:US
Practice Address - Phone:215-676-9191
Practice Address - Fax:215-856-9560
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002671L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist