Provider Demographics
NPI:1841340486
Name:WILLBANKS, DAYNA K (OTR/L)
Entity type:Individual
Prefix:MS
First Name:DAYNA
Middle Name:K
Last Name:WILLBANKS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 NW ROBERT ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-3640
Mailing Address - Country:US
Mailing Address - Phone:509-432-1575
Mailing Address - Fax:509-332-8045
Practice Address - Street 1:106 E 3RD ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2970
Practice Address - Country:US
Practice Address - Phone:509-432-1575
Practice Address - Fax:509-332-8045
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT406225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist