Individual
MATTHEW DAVID DONALDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
2300 PAVILION DR, KINGSPORT, TN 37660-4622
(423) 765-9655
Mailing address
2300 PAVILION DR, KINGSPORT, TN 37660-4622
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2108
TN
Other
Enumeration date
02/22/2018
Last updated
02/22/2018
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