Healthcare Provider Details

I. General information

NPI: 1790053650
Provider Name (Legal Business Name): DANIELLE KAY DAQUIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3767 DELAWARE AVE
KENMORE NY
14217-1040
US

IV. Provider business mailing address

3767 DELAWARE AVE
KENMORE NY
14217-1040
US

V. Phone/Fax

Practice location:
  • Phone: 716-874-6175
  • Fax:
Mailing address:
  • Phone: 716-244-0225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number023284-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number018281
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: