Provider Demographics
NPI:1730469560
Name:HEINRICHS, DANIELLE (COTA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:HEINRICHS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MONARCH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1848
Mailing Address - Country:US
Mailing Address - Phone:859-224-0834
Mailing Address - Fax:859-224-0882
Practice Address - Street 1:1001 MONARCH ST STE 110
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1848
Practice Address - Country:US
Practice Address - Phone:859-224-0834
Practice Address - Fax:859-224-0882
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2013-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA3854224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant