Provider Demographics
NPI:1245260462
Name:REISNER, DANNIELLE SUZETTE
Entity type:Individual
Prefix:
First Name:DANNIELLE
Middle Name:SUZETTE
Last Name:REISNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5428 WILCLARK RD
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-2008
Mailing Address - Country:US
Mailing Address - Phone:505-923-5322
Mailing Address - Fax:
Practice Address - Street 1:2501 BUENA VISTA SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87125-6666
Practice Address - Country:US
Practice Address - Phone:651-267-3523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist