Provider Demographics
NPI:1093245847
Name:BURT, DANIELLE (OTR)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BURT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 ENCLAVE CIR APT 307
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7086
Mailing Address - Country:US
Mailing Address - Phone:781-258-3462
Mailing Address - Fax:
Practice Address - Street 1:431 ENCLAVE CIR APT 307
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7086
Practice Address - Country:US
Practice Address - Phone:781-258-3462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist