Provider Demographics
NPI:1245583046
Name:CARSON, DANIELLE BOYER (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:BOYER
Last Name:CARSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HOLIDAY BLVD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5088
Mailing Address - Country:US
Mailing Address - Phone:985-898-2999
Mailing Address - Fax:985-898-2289
Practice Address - Street 1:410 NEW BRIDGE ST
Practice Address - Street 2:SUITE 10-A
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4739
Practice Address - Country:US
Practice Address - Phone:910-347-2212
Practice Address - Fax:910-347-6003
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8331225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics