Provider Demographics
NPI:1184814154
Name:DALY, WAYNE
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:DALY
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:WAYNE
Other - Middle Name:
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPO
Mailing Address - Street 1:6405 218TH ST SW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2180
Mailing Address - Country:US
Mailing Address - Phone:425-771-0797
Mailing Address - Fax:206-219-1144
Practice Address - Street 1:6405 218TH ST SW
Practice Address - Street 2:SUITE 301
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2180
Practice Address - Country:US
Practice Address - Phone:425-771-0797
Practice Address - Fax:206-219-1144
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPS00000011224P00000X
WAOI00000010222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9015561Medicaid