Provider Demographics
NPI:1285499863
Name:PATULOT, DANIELLE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:PATULOT
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2105
Mailing Address - Country:US
Mailing Address - Phone:732-766-1196
Mailing Address - Fax:
Practice Address - Street 1:399 RIDGE RD STE 4&5
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1656
Practice Address - Country:US
Practice Address - Phone:732-359-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01122800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist