Provider Demographics
NPI:1578225819
Name:MAGNANT, DANIELLE R (COTA/L)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:R
Last Name:MAGNANT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 HIGLEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05363-9614
Mailing Address - Country:US
Mailing Address - Phone:802-780-7722
Mailing Address - Fax:
Practice Address - Street 1:61 GREENWAY
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:VT
Practice Address - Zip Code:05354-9474
Practice Address - Country:US
Practice Address - Phone:802-254-6041
Practice Address - Fax:802-257-5362
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT073.000133224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant