Provider Demographics
NPI:1902312721
Name:YOUNGSTON, DANIELLE (MOT, OTRL)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:YOUNGSTON
Suffix:
Gender:F
Credentials:MOT, OTRL
Other - Prefix:MRS
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5365 APPLE HILL CT
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2401
Mailing Address - Country:US
Mailing Address - Phone:810-618-1634
Mailing Address - Fax:
Practice Address - Street 1:5655 CLARKSTON RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-3714
Practice Address - Country:US
Practice Address - Phone:810-618-1634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010070225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1265426704Medicaid