Provider Demographics
NPI:1043725666
Name:DAGATO, DANIELLE (OT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DAGATO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-2167
Mailing Address - Country:US
Mailing Address - Phone:732-310-4193
Mailing Address - Fax:
Practice Address - Street 1:131 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-2167
Practice Address - Country:US
Practice Address - Phone:732-310-4193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00462800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist