Healthcare Provider Details

I. General information

NPI: 1003484916
Provider Name (Legal Business Name): DANYELLE BRAELYN HUFFAKER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 CALMONT AVE
FORT WORTH TX
76116-3802
US

IV. Provider business mailing address

11431 STATE HIGHWAY 6
AVOCA TX
79503-2121
US

V. Phone/Fax

Practice location:
  • Phone: 817-400-2273
  • Fax:
Mailing address:
  • Phone: 325-669-3102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number121871
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: