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General NPI Number Information
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NPI Number | 1316106479
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Entity Type | Individual
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Provider Name | DARYL GLEN OTTAWAY RN
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Gender | Male
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Dates
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Enumeration Date | 06/04/2008
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Last Update Date | 06/04/2008
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Provider Practice Location Address
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Address Line | 3225 STATE STREET ROOM 249
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City | SALEM
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State | OR
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Zip | 97301
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Country | US
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Telephone | 503-584-2284
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Fax | 503-584-2293
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Provider Business Mailing Address
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Address Line | PO BOX 14350 1776 MILITIA WAY
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City | SALEM
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State | OR
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Zip | 97309-5047
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Country | US
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Telephone | 503-584-2284
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Fax | 503-584-2293
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WX0106X
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Taxonomy Name | Occupational Health Registered Nurse
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License Number | 200340189RN
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License Number State | OR
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