Provider Demographics
NPI:1285079939
Name:THEUNISSEN, DENIQUE MARGARET
Entity type:Individual
Prefix:MRS
First Name:DENIQUE
Middle Name:MARGARET
Last Name:THEUNISSEN
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 1:1912 ALTER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2802
Mailing Address - Country:US
Mailing Address - Phone:610-823-6604
Mailing Address - Fax:
Practice Address - Street 1:1912 ALTER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-2802
Practice Address - Country:US
Practice Address - Phone:610-823-6604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011639225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist