Provider Demographics
NPI:1992343115
Name:KRAUSE, DANIELLE (LMT, CHES)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:LMT, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52384 BARBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-9558
Mailing Address - Country:US
Mailing Address - Phone:315-532-7689
Mailing Address - Fax:
Practice Address - Street 1:52384 BARBERRY CIR
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-9558
Practice Address - Country:US
Practice Address - Phone:315-532-7689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24586225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist