Provider Demographics
NPI:1710421763
Name:DAIGLE, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DAIGLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 STEDMAN ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-2705
Mailing Address - Country:US
Mailing Address - Phone:978-677-6952
Mailing Address - Fax:
Practice Address - Street 1:229 STEDMAN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2705
Practice Address - Country:US
Practice Address - Phone:978-677-6952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician