Provider Demographics
NPI:1821552514
Name:ELLIOTT, DANIELLE (MT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20047 COUNTY HIGHWAY 114
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-7249
Mailing Address - Country:US
Mailing Address - Phone:218-205-8395
Mailing Address - Fax:
Practice Address - Street 1:20047 COUNTY HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-7249
Practice Address - Country:US
Practice Address - Phone:218-205-8395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-26
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist