Provider Demographics
NPI:1407562234
Name:WATT, DANIELLE MCKENZIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MCKENZIE
Last Name:WATT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 TIMBERLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-2240
Mailing Address - Country:US
Mailing Address - Phone:859-250-6546
Mailing Address - Fax:
Practice Address - Street 1:330 THOMAS MORE PKWY STE 102
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3421
Practice Address - Country:US
Practice Address - Phone:859-426-5666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY282355225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist