Provider Demographics
NPI:1922556877
Name:DANIELS, CHRISTOLINE NICHOLE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTOLINE
Middle Name:NICHOLE
Last Name:DANIELS
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 1:100 BENJAMIN WAY
Mailing Address - Street 2:
Mailing Address - City:HEADLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36345-8402
Mailing Address - Country:US
Mailing Address - Phone:334-718-3530
Mailing Address - Fax:
Practice Address - Street 1:100 BENJAMIN WAY
Practice Address - Street 2:
Practice Address - City:HEADLAND
Practice Address - State:AL
Practice Address - Zip Code:36345
Practice Address - Country:US
Practice Address - Phone:334-718-3530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL20172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty