Provider Demographics
NPI:1316106479
Name:OTTAWAY, DARYL GLEN (RN)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:GLEN
Last Name:OTTAWAY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 14350
Mailing Address - Street 2:1776 MILITIA WAY
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97309-5047
Mailing Address - Country:US
Mailing Address - Phone:503-584-2284
Mailing Address - Fax:503-584-2293
Practice Address - Street 1:3225 STATE STREET
Practice Address - Street 2:ROOM 249
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-584-2284
Practice Address - Fax:503-584-2293
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR200340189RN163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health