Provider Demographics
NPI:1720623820
Name:DAUGHTON, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:DAUGHTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MYRTLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1219
Mailing Address - Country:US
Mailing Address - Phone:797-445-7000
Mailing Address - Fax:707-445-7143
Practice Address - Street 1:901 MYRTLE AVENUE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1219
Practice Address - Country:US
Practice Address - Phone:797-445-7000
Practice Address - Fax:707-445-7143
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26892225X00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist