MEDICARE: DANIELLE SKINNER

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
1	224Z00000X	Occupational Therapy Assistant	004571-1	NY

General Provider Information

NPI Number	:	1477734473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE SKINNER

Provider Business Mailing Address
First Line	:	17010 130TH AVE
Second Line	:	APT 4E
City	:	JAMAICA
State	:	NY
Zip	:	11434-3254
Country	:	US
Telephone Number	:	718-813-8702
Fax Number	:

Provider Business Practice Location Address
First Line	:	3533 10TH ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-5109
Country	:	US
Telephone Number	:	718-721-3567
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2007
Last Update Date	:	11/18/2007

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