Provider Demographics
NPI:1104802776
Name:HOULIHAN, DANIEL (OT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:HOULIHAN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 561 BOX 1822
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96310
Mailing Address - Country:JP
Mailing Address - Phone:01194-253-4562
Mailing Address - Fax:
Practice Address - Street 1:BRANCH MEDICAL CLINIC / EDIS
Practice Address - Street 2:PSC 561 BOX 1877
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96310
Practice Address - Country:JP
Practice Address - Phone:01194-253-4562
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004103225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist