Individual
DANIELLE ALISHA LODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1410 DR. M.L. KING JR ST. N, SAFETY HARBOR, FL 34695
(724) 208-6649
Mailing address
1410 DR. M.L. KING JR ST. N, SAFETY HARBOR, FL 34695
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA18620
FL
Other
Enumeration date
11/08/2021
Last updated
11/08/2021
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