Healthcare Provider Details

I. General information

NPI: 1780822874
Provider Name (Legal Business Name): CHRISTINE M DALY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

852 COMMERCE AVE
LONGVIEW WA
98632-2406
US

IV. Provider business mailing address

PO BOX 3002
LONGVIEW WA
98632-0302
US

V. Phone/Fax

Practice location:
  • Phone: 360-501-3750
  • Fax: 360-501-3755
Mailing address:
  • Phone: 360-414-2048
  • Fax: 360-414-2054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00004194
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: