Provider Demographics
NPI:1396319893
Name:FLATLEY, DANA (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:FLATLEY
Suffix:
Gender:F
Credentials: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 1:708 BROOK MANOR CT
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-4513
Mailing Address - Country:US
Mailing Address - Phone:636-328-7852
Mailing Address - Fax:
Practice Address - Street 1:135 MEADOWLANDS ESTATES LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4712
Practice Address - Country:US
Practice Address - Phone:636-614-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014034797225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist