Provider Demographics
NPI:1790946796
Name:DALY, SHANNON D (OT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:D
Last Name:DALY
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 1:10811 SE KENT KANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7108
Mailing Address - Country:US
Mailing Address - Phone:253-854-5660
Mailing Address - Fax:253-854-7025
Practice Address - Street 1:10811 SE KENT KANGLEY RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7108
Practice Address - Country:US
Practice Address - Phone:253-854-5660
Practice Address - Fax:253-854-7025
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1092828Medicaid
WA600337984Medicare UPIN