Healthcare Provider Details

I. General information

NPI: 1780692137
Provider Name (Legal Business Name): DARALEEN SITKA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 819 BOX 50
FPO AE
09645-0050
ES

IV. Provider business mailing address

PSC 819 BOX 50
FPO AE
09645-0050
ES

V. Phone/Fax

Practice location:
  • Phone: 34956847390
  • Fax:
Mailing address:
  • Phone: 34956847390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number00445544
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: