Provider Demographics
NPI:1396098331
Name:ALDER, DANIELLE KATHRYN (OTR/L)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KATHRYN
Last Name:ALDER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-1307
Mailing Address - Country:US
Mailing Address - Phone:570-855-4501
Mailing Address - Fax:
Practice Address - Street 1:500 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1508
Practice Address - Country:US
Practice Address - Phone:570-586-3587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006444L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist