MEDICARE: DANIELLE DOUGLAS

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	225000000X	Orthotic Fitter

General Provider Information

NPI Number	:	1821553355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE DOUGLAS

Provider Business Mailing Address
First Line	:	2260 S CHURCH ST STE 601
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-5380
Country	:	US
Telephone Number	:	336-494-5768
Fax Number	:

Provider Business Practice Location Address
First Line	:	2260 S CHURCH ST STE 601
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27215-5380
Country	:	US
Telephone Number	:	336-494-5768
Fax Number	:

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

Provider Enumeration Date	:	02/08/2019
Last Update Date	:	02/08/2019

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Directions to “ DANIELLE DOUGLAS ” Practice Location

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