Provider Demographics
NPI:1306340930
Name:BURROUGHS, DANIELLE (OTR)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BURROUGHS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 SE 24TH RD # R
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6005
Mailing Address - Country:US
Mailing Address - Phone:352-629-8900
Mailing Address - Fax:
Practice Address - Street 1:1501 SE 24TH RD # R
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6005
Practice Address - Country:US
Practice Address - Phone:352-629-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11548225X00000X
FLOT16893225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist