Provider Demographics
NPI:1497561161
Name:DANIELS, OCTAVIA MICHELLE
Entity type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:MICHELLE
Last Name:DANIELS
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 1:7502 MILLIGAN LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3018
Mailing Address - Country:US
Mailing Address - Phone:301-213-8118
Mailing Address - Fax:
Practice Address - Street 1:202 34TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1309
Practice Address - Country:US
Practice Address - Phone:202-476-9553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant