Provider Demographics
NPI:1073903597
Name:HODUT, DANIELLE CHRISTA (OTR/L)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:CHRISTA
Last Name:HODUT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:CHRISTA
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:6219 POTTER SPRING CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5144
Mailing Address - Country:US
Mailing Address - Phone:904-666-8475
Mailing Address - Fax:
Practice Address - Street 1:6219 POTTER SPRING CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5144
Practice Address - Country:US
Practice Address - Phone:904-666-8475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16560225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist