Provider Demographics
NPI:1568250942
Name:DANIELSON, KELLY LEIGHTON (OTD, MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LEIGHTON
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:OTD, MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10982 NE OLD CREOSOTE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3126
Mailing Address - Country:US
Mailing Address - Phone:206-852-4311
Mailing Address - Fax:
Practice Address - Street 1:563 MADISON AVE N
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1768
Practice Address - Country:US
Practice Address - Phone:206-855-8455
Practice Address - Fax:206-855-8465
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60352838225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist