MEDICARE: DANIELLE MARIE BIRCKHEAD

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	P80350	NY

General Provider Information

NPI Number	:	1437445749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE MARIE BIRCKHEAD

Provider Business Mailing Address
First Line	:	3975 DOUGLAS HEIGHTS DR
Second Line	:
City	:	CANASTOTA
State	:	NY
Zip	:	13032-4729
Country	:	US
Telephone Number	:	315-532-1816
Fax Number	:

Provider Business Practice Location Address
First Line	:	3975 DOUGLAS HEIGHTS DR
Second Line	:
City	:	CANASTOTA
State	:	NY
Zip	:	13032-4729
Country	:	US
Telephone Number	:	315-532-1816
Fax Number	:

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

Provider Enumeration Date	:	06/24/2011
Last Update Date	:	03/28/2024

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