Provider Demographics
NPI:1366705477
Name:DU NANN, DANIELLE AMI (OTR/L)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:AMI
Last Name:DU NANN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 25TH AVE NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4107
Mailing Address - Country:US
Mailing Address - Phone:206-388-3751
Mailing Address - Fax:
Practice Address - Street 1:906 SE EVERETT MALL WAY STE 200
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3743
Practice Address - Country:US
Practice Address - Phone:425-353-5656
Practice Address - Fax:425-513-2807
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 60269570225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2019844Medicaid