Individual
MS. DONNA LYNN CHILDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.R
Contact information
Practice address
475 MEMORY LN, BOULDER CREEK, CA 95006-9130
(707) 445-8080
(707) 445-8088
Mailing address
2332 HARRISON AVE, SUITE D, EUREKA, CA 95501-3234
(707) 445-8080
(707) 445-8088
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1013690
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013690
OTR LICENSE
CA
01
—
271 82 7541
SS#
CA
01
—
362098200
FEDERAL WORKERS' COMP
CA
01
—
OT0053780
BLUE SHIELD
CA
Enumeration date
02/09/2007
Last updated
07/01/2021
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