Provider Demographics
NPI:1225115819
Name:DAILEY, DEBORAH S (OTR/L, CLT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:DAILEY
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:DAILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L, CLT
Mailing Address - Street 1:PO BOX 5285
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5285
Mailing Address - Country:US
Mailing Address - Phone:308-675-1853
Mailing Address - Fax:308-210-4121
Practice Address - Street 1:905 N CUSTER AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4304
Practice Address - Country:US
Practice Address - Phone:308-398-2170
Practice Address - Fax:308-398-5232
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOT-1497225X00000X
MS3921225X00000X
NE628225X00000X
NC8538225X00000X
SC1511225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYOT-1497OtherSTATE ISSUED OCCUPATIONAL THERAPY LICENSE