Provider Demographics
NPI:1528398443
Name:SPEAKMAN, DANYELLE (LMT)
Entity Type:Individual
Prefix:
First Name:DANYELLE
Middle Name:
Last Name:SPEAKMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1042
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-7042
Mailing Address - Country:US
Mailing Address - Phone:740-418-8838
Mailing Address - Fax:
Practice Address - Street 1:19 W SOUTH ST
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1502
Practice Address - Country:US
Practice Address - Phone:740-418-8838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33-016867225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist