Provider Demographics
NPI:1104210954
Name:COLLINS, DANIELLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:FEIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:204 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1421
Mailing Address - Country:US
Mailing Address - Phone:631-974-4952
Mailing Address - Fax:
Practice Address - Street 1:395 SUNKEN MEADOW RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-1000
Practice Address - Country:US
Practice Address - Phone:631-269-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY685875163W00000X
NY024406225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No163W00000XNursing Service ProvidersRegistered Nurse