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NPI Code Detail

MEDICARE: DANIELLE STARK

MEDICARE: DANIELLE STARK
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1477394377
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE STARK
Provider Business Mailing Address
First Line : 4435 24TH AVE
Second Line :
City : FORT GRATIOT
State : MI
Zip : 48059-3810
Country : US
Telephone Number : 810-479-9375
Fax Number : 734-822-0237
Provider Business Practice Location Address
First Line : 4435 24TH AVE
Second Line :
City : FORT GRATIOT
State : MI
Zip : 48059-3810
Country : US
Telephone Number : 810-479-9375
Fax Number : 734-822-0237
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2024
Last Update Date : 06/04/2024

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Directions to “ DANIELLE STARK ” Practice Location

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