Provider Demographics
NPI:1629543582
Name:UTMAN, DANIELLE LOUISE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LOUISE
Last Name:UTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W BROAD ST UNIT 406
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3789
Mailing Address - Country:US
Mailing Address - Phone:203-674-0607
Mailing Address - Fax:
Practice Address - Street 1:999 PELHAM PKWY N
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-4905
Practice Address - Country:US
Practice Address - Phone:718-519-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011863225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics