Healthcare Provider Details

I. General information

NPI: 1568250942
Provider Name (Legal Business Name): KELLY LEIGHTON DANIELSON OTD, MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 MADISON AVE N
BAINBRIDGE ISLAND WA
98110-1768
US

IV. Provider business mailing address

10982 NE OLD CREOSOTE HILL RD
BAINBRIDGE ISLAND WA
98110-3126
US

V. Phone/Fax

Practice location:
  • Phone: 206-855-8455
  • Fax: 206-855-8465
Mailing address:
  • Phone: 206-852-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT60352838
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: