Provider Demographics
NPI:1457870016
Name:O'BRIEN, DANIELLE MARGARET (COTA)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:MARGARET
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 ALDER ST
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-1059
Mailing Address - Country:US
Mailing Address - Phone:715-896-9841
Mailing Address - Fax:
Practice Address - Street 1:316 SUNSET PL
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-1708
Practice Address - Country:US
Practice Address - Phone:715-743-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5393-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant