Provider Demographics
NPI:1831784875
Name:BACON, DANIELLE LOUISE (OTR/L CHT CLT-LANA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LOUISE
Last Name:BACON
Suffix:
Gender:F
Credentials:OTR/L CHT CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34990
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0627
Mailing Address - Country:US
Mailing Address - Phone:610-768-1610
Mailing Address - Fax:833-941-3871
Practice Address - Street 1:2600 EASTON RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1010
Practice Address - Country:US
Practice Address - Phone:610-768-1610
Practice Address - Fax:833-941-3871
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006270L225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand