Provider Demographics
NPI:1083876791
Name:SMITH, DANIELLE M (OTR L)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767
Mailing Address - Country:US
Mailing Address - Phone:814-938-7144
Mailing Address - Fax:
Practice Address - Street 1:537 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2580
Practice Address - Country:US
Practice Address - Phone:814-938-7144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility