Provider Demographics
NPI:1962146670
Name:WILLS, DANIELLE (ATC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:WILLS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:WILLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC
Mailing Address - Street 1:13405 LOCHMOOR CIR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-3772
Mailing Address - Country:US
Mailing Address - Phone:813-373-0925
Mailing Address - Fax:
Practice Address - Street 1:900 N CLARKSON ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-4254
Practice Address - Country:US
Practice Address - Phone:402-941-6359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer