Provider Demographics
NPI:1225512247
Name:BLASE, DANIELLE LORINDA (COTA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LORINDA
Last Name:BLASE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 GRANTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-4012
Mailing Address - Country:US
Mailing Address - Phone:216-965-4236
Mailing Address - Fax:
Practice Address - Street 1:19205 PEARL RD APT 203
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-6903
Practice Address - Country:US
Practice Address - Phone:440-219-8324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA006969224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant