Provider Demographics
NPI:1003284225
Name:FAULK, DANIELLE NESTER (MOT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NESTER
Last Name:FAULK
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5638
Mailing Address - Country:US
Mailing Address - Phone:337-475-1053
Mailing Address - Fax:337-475-1048
Practice Address - Street 1:208 W MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5638
Practice Address - Country:US
Practice Address - Phone:337-475-1053
Practice Address - Fax:337-475-1048
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist