Provider Demographics
NPI:1609230671
Name:MUSGROVE, DANIELLE (COTA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MUSGROVE
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 1:314 WHITING CT
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4616
Mailing Address - Country:US
Mailing Address - Phone:251-367-5613
Mailing Address - Fax:800-721-2101
Practice Address - Street 1:314 WHITING CT
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4616
Practice Address - Country:US
Practice Address - Phone:251-367-5613
Practice Address - Fax:800-721-2101
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3705224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant