Provider Demographics
NPI:1366753220
Name:SHIVERICK, DANIELLE MARIE (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:MARIE
Last Name:SHIVERICK
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:ECKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:11539 PARK WOODS CIR
Mailing Address - Street 2:SUITE 502
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4413
Mailing Address - Country:US
Mailing Address - Phone:678-527-3224
Mailing Address - Fax:678-366-5886
Practice Address - Street 1:11539 PARK WOODS CIR
Practice Address - Street 2:SUITE 502
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4413
Practice Address - Country:US
Practice Address - Phone:678-527-3224
Practice Address - Fax:678-366-5886
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006221225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003162689AMedicaid