Provider Demographics
NPI:1659929362
Name:ATHMANN, DANIELLE CHARLENE (OTR/L)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:CHARLENE
Last Name:ATHMANN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:CHARLENE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8980 ZACHARY LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4018
Mailing Address - Country:US
Mailing Address - Phone:763-231-2000
Mailing Address - Fax:
Practice Address - Street 1:8980 ZACHARY LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4018
Practice Address - Country:US
Practice Address - Phone:763-231-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106046225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist