Provider Demographics
NPI:1356578181
Name:DALY, CATHERINE G (OTR/L)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:G
Last Name:DALY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:G
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:101 HUNTING TOWER DR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5827
Mailing Address - Country:US
Mailing Address - Phone:401-378-7647
Mailing Address - Fax:
Practice Address - Street 1:101 HUNTING TOWER DR
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-5827
Practice Address - Country:US
Practice Address - Phone:401-378-7647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006317225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003172335AMedicaid