Provider Demographics
NPI:1750827457
Name:DARROCH, DANIELLE (ATC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DARROCH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4926 LAKERIDGE ST APT TB
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1424
Mailing Address - Country:US
Mailing Address - Phone:630-885-7459
Mailing Address - Fax:
Practice Address - Street 1:4926 LAKERIDGE ST APT TB
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1424
Practice Address - Country:US
Practice Address - Phone:630-885-7459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960041282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2000021446OtherNATA BOC