Healthcare Provider Details

I. General information

NPI: 1629680392
Provider Name (Legal Business Name): DANIELLE HALASZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE HICKEN OTR/L

II. Dates (important events)

Enumeration Date: 08/23/2020
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 BEACH BLVD
JACKSONVILLE BEACH FL
32250-3445
US

IV. Provider business mailing address

1661 RIVERSIDE AVE APT 320
JACKSONVILLE FL
32204-4025
US

V. Phone/Fax

Practice location:
  • Phone: 904-450-5061
  • Fax:
Mailing address:
  • Phone: 904-566-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number19468
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: