Provider Demographics
NPI:1336272582
Name:BERG, DANIELLE NICHOLE (MA, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:NICHOLE
Last Name:BERG
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:NICOLE
Other - Last Name:ROSENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, OTR/L
Mailing Address - Street 1:101 EAST STATE STREET
Mailing Address - Street 2:GENESIS REHAB SERVICES
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348
Mailing Address - Country:US
Mailing Address - Phone:866-386-3516
Mailing Address - Fax:610-347-6246
Practice Address - Street 1:2 GRACEDALE AVE
Practice Address - Street 2:GRACEDALE SKILLED NURSING FACILITY
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064
Practice Address - Country:US
Practice Address - Phone:610-746-1908
Practice Address - Fax:610-746-1901
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1980225X00000X
PAOC011436225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161891721Medicaid