Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003402538 |
---|---|
Provider Name | Abigail Rose Danielson |
First Address | Chesterfield, MO 63017-4778 |
Second Address | Chesterfield, MO 63017-4778 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2020 |
Last Update Date | 18/12/2020 |