Healthcare Provider Details

I. General information

NPI: 1467057950
Provider Name (Legal Business Name): DANIELLE COMPTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 BUCK CREEK PL
GREEN CV SPGS FL
32043-8628
US

IV. Provider business mailing address

2870 BUCK CREEK PL
GREEN CV SPGS FL
32043-8628
US

V. Phone/Fax

Practice location:
  • Phone: 614-562-0459
  • Fax:
Mailing address:
  • Phone: 614-562-0459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-136671
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: