Provider Demographics
NPI:1558859777
Name:FONTANA, DANIELLE JORDAN (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JORDAN
Last Name:FONTANA
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5236 W BRITTANY PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3788
Mailing Address - Country:US
Mailing Address - Phone:303-347-9356
Mailing Address - Fax:
Practice Address - Street 1:1500 W LITTLETON BLVD STE 127
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2177
Practice Address - Country:US
Practice Address - Phone:720-684-5877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005351225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist