Provider Demographics
NPI:1184331597
Name:PERALES, DANIELLE (COTA/L)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:PERALES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:TEMPLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3521 IVY CREST WAY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4475
Mailing Address - Country:US
Mailing Address - Phone:401-216-9564
Mailing Address - Fax:678-951-8226
Practice Address - Street 1:941 PROGRESS RD
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-5599
Practice Address - Country:US
Practice Address - Phone:401-216-9564
Practice Address - Fax:678-951-8226
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002357224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant