Provider Demographics
NPI:1548676398
Name:STOFFERS, DANIELLE (COTA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:STOFFERS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 ATLANTIC ST
Mailing Address - Street 2:324
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-2463
Mailing Address - Country:US
Mailing Address - Phone:321-514-0626
Mailing Address - Fax:
Practice Address - Street 1:1905 ATLANTIC ST
Practice Address - Street 2:324
Practice Address - City:MELBOURNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32951-2463
Practice Address - Country:US
Practice Address - Phone:321-514-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212555224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant