Provider Demographics
NPI:1841590221
Name:EARLEY, DANA RAQUEL (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:RAQUEL
Last Name:EARLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:DANA
Other - Middle Name:RAQUEL
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42755-0007
Mailing Address - Country:US
Mailing Address - Phone:270-589-1292
Mailing Address - Fax:
Practice Address - Street 1:308 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1265
Practice Address - Country:US
Practice Address - Phone:270-589-1292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4652225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist