Provider Demographics
NPI:1720486905
Name:DEWAILLY, DANIELLE YAMILE (COTA)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:YAMILE
Last Name:DEWAILLY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 NATHAN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-4515
Mailing Address - Country:US
Mailing Address - Phone:512-284-8386
Mailing Address - Fax:
Practice Address - Street 1:2204 NATHAN DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-4515
Practice Address - Country:US
Practice Address - Phone:512-284-8386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-20
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211817235Z00000X, 224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist