Provider Demographics
NPI:1790083772
Name:DAHLKE, DANIEL H (COTA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:H
Last Name:DAHLKE
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CHATEAU TER
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3927
Mailing Address - Country:US
Mailing Address - Phone:716-839-1655
Mailing Address - Fax:716-836-1656
Practice Address - Street 1:25 CHATEAU TER
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-3927
Practice Address - Country:US
Practice Address - Phone:716-839-1655
Practice Address - Fax:716-839-1656
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002896-1172V00000X
NY002896-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No172V00000XOther Service ProvidersCommunity Health Worker