Healthcare Provider Details

I. General information

NPI: 1780473512
Provider Name (Legal Business Name): DANIELLE D MENTING OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S30W24784 W SUNSET DR STE E
WAUKESHA WI
53189-7013
US

IV. Provider business mailing address

104 N 74TH ST
MILWAUKEE WI
53213-3627
US

V. Phone/Fax

Practice location:
  • Phone: 262-698-0819
  • Fax:
Mailing address:
  • Phone: 920-428-6978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number5302-26
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5302-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: