Provider Demographics
NPI:1700518503
Name:DENNIS, DANIELLE ASHLEY (COTA/L)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ASHLEY
Last Name:DENNIS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:ASHLEY
Other - Last Name:PORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9881 BRIDGEPORT WAY SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9881 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2805
Practice Address - Country:US
Practice Address - Phone:253-753-4008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant