Provider Demographics
NPI:1932358454
Name:DANIELLO, KATHERINE LYNN (PT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LYNN
Last Name:DANIELLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22317 DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-2153
Mailing Address - Country:US
Mailing Address - Phone:302-856-7364
Mailing Address - Fax:
Practice Address - Street 1:22317 DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-2153
Practice Address - Country:US
Practice Address - Phone:302-856-7364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001273174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist