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NPI Code Detail

MEDICARE: DANIELLE TRUITT

MEDICARE:   DANIELLE  TRUITT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Q00000XDevelopmental Therapist1145131NC

General Provider Information

NPI Number : 1336545037
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE TRUITT
Provider Business Mailing Address
First Line : 7510 WINDMILL HARBOR WAY
Second Line :
City : RALEIGH
State : NC
Zip : 27617-8673
Country : US
Telephone Number : 410-925-0526
Fax Number : 919-263-9605
Provider Business Practice Location Address
First Line : 324 BENDEMEER LN
Second Line :
City : ROLESVILLE
State : NC
Zip : 27571-9731
Country : US
Telephone Number : 919-673-4246
Fax Number : 919-263-9605
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2014
Last Update Date : 11/07/2014

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