Provider Demographics
NPI:1124400676
Name:ULEKOWSKI, DANIELLE ALICE (ATC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ALICE
Last Name:ULEKOWSKI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3281 OWENS MEADOW LN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-2585
Mailing Address - Country:US
Mailing Address - Phone:352-284-9042
Mailing Address - Fax:
Practice Address - Street 1:3281 OWENS MEADOW LN NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-2585
Practice Address - Country:US
Practice Address - Phone:352-284-9042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260021252255A2300X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
M5037133OtherNREMT