Provider Demographics
NPI:1003002619
Name:MILES, DANIELLE N (PTA)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:N
Last Name:MILES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:NICOLE
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:383 GOODYEAR AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-2311
Mailing Address - Country:US
Mailing Address - Phone:716-426-8576
Mailing Address - Fax:
Practice Address - Street 1:383 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-2311
Practice Address - Country:US
Practice Address - Phone:716-426-8576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005991225200000X
NY021936225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant