Provider Demographics
NPI:1467661942
Name:DALEY, LLANA C (OTR/L)
Entity type:Individual
Prefix:
First Name:LLANA
Middle Name:C
Last Name:DALEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LLANA
Other - Middle Name:C
Other - Last Name:DALEY BOWEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5450 NW COMER ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-4013
Mailing Address - Country:US
Mailing Address - Phone:772-344-7392
Mailing Address - Fax:
Practice Address - Street 1:1699 SE LYNGATE DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5016
Practice Address - Country:US
Practice Address - Phone:772-337-2408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8075225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist