Provider Demographics
NPI:1780214684
Name:LAVERE, DANIELLE NINA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NINA
Last Name:LAVERE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-3208
Mailing Address - Country:US
Mailing Address - Phone:302-757-9072
Mailing Address - Fax:
Practice Address - Street 1:2226 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-3208
Practice Address - Country:US
Practice Address - Phone:302-757-9072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08450225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist