Provider Demographics
NPI:1356107981
Name:LAMM, DANIELLE M (MOTR/L, CLT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:LAMM
Suffix:
Gender:F
Credentials:MOTR/L, CLT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:M
Other - Last Name:KISBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10811 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-5081
Mailing Address - Country:US
Mailing Address - Phone:712-310-1482
Mailing Address - Fax:
Practice Address - Street 1:2306 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1048
Practice Address - Country:US
Practice Address - Phone:712-322-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2390225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist