Provider Demographics
NPI:1174965305
Name:SMITH, DANIELLE RENEE (CO)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E MOREHEAD ST
Mailing Address - Street 2:SUITE 280
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2301
Mailing Address - Country:US
Mailing Address - Phone:704-344-1290
Mailing Address - Fax:704-344-1292
Practice Address - Street 1:309 E MOREHEAD ST
Practice Address - Street 2:SUITE 280
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2301
Practice Address - Country:US
Practice Address - Phone:704-344-1290
Practice Address - Fax:704-344-1292
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT216222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist