Healthcare Provider Details

I. General information

NPI: 1235511510
Provider Name (Legal Business Name): DANIELE FALLON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 E 40TH ST
GARDEN CITY ID
83714-6358
US

IV. Provider business mailing address

522 E 40TH ST
GARDEN CITY ID
83714-6358
US

V. Phone/Fax

Practice location:
  • Phone: 208-918-2657
  • Fax: 208-906-2342
Mailing address:
  • Phone: 208-918-2657
  • Fax: 208-906-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-2184
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: