Provider Demographics
NPI:1043970577
Name:BLACK, DANIELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:636 WHITE OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:GARDNERS
Mailing Address - State:PA
Mailing Address - Zip Code:17324-9589
Mailing Address - Country:US
Mailing Address - Phone:717-781-3223
Mailing Address - Fax:
Practice Address - Street 1:785 CHERRY TREE CT
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-7902
Practice Address - Country:US
Practice Address - Phone:717-316-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-24
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC018135225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist