Provider Demographics
NPI:1689304750
Name:RUZICKA, DANIELLE RAE (OT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RAE
Last Name:RUZICKA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:RAE
Other - Last Name:HILDEBRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:39081 GREENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-8105
Mailing Address - Country:US
Mailing Address - Phone:507-317-7276
Mailing Address - Fax:
Practice Address - Street 1:305 S STATE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4527
Practice Address - Country:US
Practice Address - Phone:605-622-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1283225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist