Provider Demographics
NPI:1104443746
Name:WHITWORTH, DANIELLE LEE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LEE
Last Name:WHITWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 N MONROE ST STE 114
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2623
Mailing Address - Country:US
Mailing Address - Phone:509-252-0800
Mailing Address - Fax:
Practice Address - Street 1:1312 N MONROE ST STE 114
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2623
Practice Address - Country:US
Practice Address - Phone:509-252-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61053274225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist