MEDICARE: MISS DANIELLE T ROBILLARD L.M.T.

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	174400000X	Specialist	015367	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	015367-1	OTHER	NY	STATE OF NY EDUCATION DEPARTMENT OFFICE OF THE PROFESSIONS

General Provider Information

NPI Number	:	1871737353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DANIELLE T ROBILLARD L.M.T.

Provider Business Mailing Address
First Line	:	56 SHERMAN AVE
Second Line	:
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-2753
Country	:	US
Telephone Number	:	518-222-4333
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 SHERMAN AVE
Second Line	:
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-2753
Country	:	US
Telephone Number	:	518-222-4333
Fax Number	:

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

Provider Enumeration Date	:	04/28/2009
Last Update Date	:	04/28/2009

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