Provider Demographics
NPI:1790334845
Name:DAILY, PENELPE FLETCHER (OT)
Entity Type:Individual
Prefix:
First Name:PENELPE
Middle Name:FLETCHER
Last Name:DAILY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13924 MARQUESAS WAY APT 1126
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6014
Mailing Address - Country:US
Mailing Address - Phone:310-715-9174
Mailing Address - Fax:
Practice Address - Street 1:13924 MARQUESAS WAY APT 1126
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6014
Practice Address - Country:US
Practice Address - Phone:310-715-9174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT10773225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty