Provider Demographics
NPI:1639898190
Name:MOOS, DANIELLE (OT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MOOS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:BALLOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:303 ALAMEDA PKWY
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1405
Mailing Address - Country:US
Mailing Address - Phone:610-639-1708
Mailing Address - Fax:
Practice Address - Street 1:2644 RIVA RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7427
Practice Address - Country:US
Practice Address - Phone:410-222-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08526225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist