Provider Demographics
NPI:1437802592
Name:ELLIS, DANIEL JOHN
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:ELLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 SE SENTRY DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-4001
Mailing Address - Country:US
Mailing Address - Phone:509-525-1514
Mailing Address - Fax:
Practice Address - Street 1:1710 PLAZA WAY
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4362
Practice Address - Country:US
Practice Address - Phone:509-529-4218
Practice Address - Fax:509-522-1729
Is Sole Proprietor?:No
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003242225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist