Provider Demographics
NPI:1942407846
Name:DONOVAN, CANDACE MIRIAM (OTL)
Entity type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:MIRIAM
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 169
Mailing Address - Street 2:370 PIERCE RD.
Mailing Address - City:BLAINE
Mailing Address - State:ME
Mailing Address - Zip Code:04734-0169
Mailing Address - Country:US
Mailing Address - Phone:207-425-2581
Mailing Address - Fax:207-425-2581
Practice Address - Street 1:93 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:ME
Practice Address - Zip Code:04736-2038
Practice Address - Country:US
Practice Address - Phone:207-227-2677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT101225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation