Provider Demographics
NPI:1255468336
Name:GENAWAY, DANIELLE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:GENAWAY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DEERING CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4085
Mailing Address - Country:US
Mailing Address - Phone:631-286-2871
Mailing Address - Fax:631-286-2871
Practice Address - Street 1:4 DEERING CT
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-4085
Practice Address - Country:US
Practice Address - Phone:631-286-2871
Practice Address - Fax:631-286-2871
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006610-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist