Provider Demographics
NPI:1417298704
Name:RISNER, DANIELLE (OTR)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:RISNER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:JOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:LUTHER HOME 831 PINE BEACH RD
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143
Mailing Address - Country:US
Mailing Address - Phone:715-732-5796
Mailing Address - Fax:715-732-5676
Practice Address - Street 1:LUTHER HOME 831 PINE BEACH RD
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143
Practice Address - Country:US
Practice Address - Phone:715-732-5796
Practice Address - Fax:715-732-5676
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5210-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist