Healthcare Provider Details

I. General information

NPI: 1265508113
Provider Name (Legal Business Name): DANIELLE LUCIA DRAKSLER ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 01/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 QUARRY LAKE DRIVE SUITE 300
BALTIMORE MD
21209
US

IV. Provider business mailing address

2700 QUARRY LAKE DR SUITE 300
BALTIMORE MD
21209-3742
US

V. Phone/Fax

Practice location:
  • Phone: 410-377-8900
  • Fax: 410-484-4879
Mailing address:
  • Phone: 410-377-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: