Provider Demographics
NPI:1144870353
Name:DANEAULT, DOREEN JOY (OTR/L)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:JOY
Last Name:DANEAULT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DOREEN
Other - Middle Name:JOY
Other - Last Name:DUVAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:484 WILLIAMSON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8191
Mailing Address - Country:US
Mailing Address - Phone:704-793-8475
Mailing Address - Fax:
Practice Address - Street 1:484 WILLIAMSON RD STE 102
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8191
Practice Address - Country:US
Practice Address - Phone:704-746-9698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
NC12844225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty