Provider Demographics
NPI:1588893630
Name:ALLARDYCE, DANIELLE MAE (MOTR/L)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:MAE
Last Name:ALLARDYCE
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 11TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-4404
Mailing Address - Country:US
Mailing Address - Phone:309-796-0922
Mailing Address - Fax:309-792-2751
Practice Address - Street 1:4747 11TH ST
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4404
Practice Address - Country:US
Practice Address - Phone:309-796-0922
Practice Address - Fax:309-792-2751
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007548225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist