Provider Demographics
NPI:1538671029
Name:LAWRENCE, DANIELLE MICHELLE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MICHELLE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 ERIN CT
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-8107
Mailing Address - Country:US
Mailing Address - Phone:608-334-9016
Mailing Address - Fax:
Practice Address - Street 1:1164 FARNHAM ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-1804
Practice Address - Country:US
Practice Address - Phone:608-334-9016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1056-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer