Provider Demographics
NPI:1073958039
Name:DANIELS, TELETHA LASHONE (OTA)
Entity Type:Individual
Prefix:MS
First Name:TELETHA
Middle Name:LASHONE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 LINNS WAY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3153
Mailing Address - Country:US
Mailing Address - Phone:409-291-6329
Mailing Address - Fax:
Practice Address - Street 1:705 HIGHWAY 418 W
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656
Practice Address - Country:US
Practice Address - Phone:409-385-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-05
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212144224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant