Healthcare Provider Details

I. General information

NPI: 1720623820
Provider Name (Legal Business Name): NATALIE DAUGHTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 02/05/2025
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MYRTLE AVENUE
EUREKA CA
95501-1219
US

IV. Provider business mailing address

901 MYRTLE AVENUE
EUREKA CA
95501-1219
US

V. Phone/Fax

Practice location:
  • Phone: 797-445-7000
  • Fax: 707-445-7143
Mailing address:
  • Phone: 797-445-7000
  • Fax: 707-445-7143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number26892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: