Provider Demographics
NPI:1306369384
Name:EDWARDS, DANIELLE PELAYO (COTA/L)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:PELAYO
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 W 28TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-2679
Mailing Address - Country:US
Mailing Address - Phone:719-694-6524
Mailing Address - Fax:
Practice Address - Street 1:3128 BOXELDER DR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5808
Practice Address - Country:US
Practice Address - Phone:307-634-7901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1235224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant