MEDICARE: DANYELLE BRAELYN HUFFAKER OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	121871	TX

General Provider Information

NPI Number	:	1003484916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANYELLE BRAELYN HUFFAKER OTR

Provider Business Mailing Address
First Line	:	11431 STATE HIGHWAY 6
Second Line	:
City	:	AVOCA
State	:	TX
Zip	:	79503-2121
Country	:	US
Telephone Number	:	325-669-3102
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 CALMONT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-3802
Country	:	US
Telephone Number	:	817-400-2273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	06/16/2021

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