Provider Demographics
NPI:1619584604
Name:DUROCHER, DANYELLE (OTD)
Entity Type:Individual
Prefix:
First Name:DANYELLE
Middle Name:
Last Name:DUROCHER
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 AMITY RD STE 5B-295
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5965
Mailing Address - Country:US
Mailing Address - Phone:501-467-4995
Mailing Address - Fax:
Practice Address - Street 1:500 AMITY RD STE 5B-295
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5948
Practice Address - Country:US
Practice Address - Phone:501-467-4995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3404225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR255688721Medicaid