Provider Demographics
NPI:1881728988
Name:OSUNA, DANIEL WAYNE (COTA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:WAYNE
Last Name:OSUNA
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ALEGRE ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88022-9748
Mailing Address - Country:US
Mailing Address - Phone:505-388-2219
Mailing Address - Fax:
Practice Address - Street 1:2810 N SWAN ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5853
Practice Address - Country:US
Practice Address - Phone:505-956-2000
Practice Address - Fax:505-956-2055
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM921224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant