Provider Demographics
NPI:1548815327
Name:DONNELLY, CHERYL ANN
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 DECKER RD
Mailing Address - Street 2:
Mailing Address - City:GLEN SPEY
Mailing Address - State:NY
Mailing Address - Zip Code:12737-5756
Mailing Address - Country:US
Mailing Address - Phone:845-856-4905
Mailing Address - Fax:
Practice Address - Street 1:535 DECKER RD
Practice Address - Street 2:
Practice Address - City:GLEN SPEY
Practice Address - State:NY
Practice Address - Zip Code:12737-5756
Practice Address - Country:US
Practice Address - Phone:845-856-4905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008569-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant