Provider Demographics
NPI:1366683534
Name:DALY, MARICLARE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:MARICLARE
Middle Name:
Last Name:DALY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4993 SE 30TH AVE APT 98
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-4580
Mailing Address - Country:US
Mailing Address - Phone:971-279-5108
Mailing Address - Fax:
Practice Address - Street 1:2106 NE 47TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2064
Practice Address - Country:US
Practice Address - Phone:503-282-7581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2014-03-28
Deactivation Date:2011-11-22
Deactivation Code:
Reactivation Date:2014-03-28
Provider Licenses
StateLicense IDTaxonomies
OR15608225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist