Provider Demographics
NPI:1508475344
Name:COLLINS, DANIELLE KRISTA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KRISTA
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:KRISTA
Other - Last Name:CAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:209 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1721
Mailing Address - Country:US
Mailing Address - Phone:570-664-6005
Mailing Address - Fax:570-664-6885
Practice Address - Street 1:209 N 8TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1721
Practice Address - Country:US
Practice Address - Phone:570-664-6005
Practice Address - Fax:570-664-6885
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017036225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103810203-0003Medicaid