Healthcare Provider Details

I. General information

NPI: 1992272280
Provider Name (Legal Business Name): DANIELLE NOREEN LASLEY MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 ROSEBUD LN
NEWBURGH IN
47630-9286
US

IV. Provider business mailing address

1003 BURLEW BLVD STE C
OWENSBORO KY
42303-1799
US

V. Phone/Fax

Practice location:
  • Phone: 812-909-1961
  • Fax: 812-909-2961
Mailing address:
  • Phone: 270-688-8449
  • Fax: 270-240-4840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number244907
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: