Provider Demographics
NPI:1437870524
Name:JURGENS, DANIELLE LORRAINE (COTA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LORRAINE
Last Name:JURGENS
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 1:209 SIBLEY DR
Mailing Address - Street 2:
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-9327
Mailing Address - Country:US
Mailing Address - Phone:815-474-4362
Mailing Address - Fax:
Practice Address - Street 1:209 SIBLEY DR
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-9327
Practice Address - Country:US
Practice Address - Phone:815-474-4362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist