Provider Demographics
NPI:1730380841
Name:MENDIOLA, DANIEL CRUZ (OTRL, CHT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:CRUZ
Last Name:MENDIOLA
Suffix:
Gender:M
Credentials:OTRL, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 LILLY RD NE STE 240
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5117
Mailing Address - Country:US
Mailing Address - Phone:360-413-3850
Mailing Address - Fax:360-359-4726
Practice Address - Street 1:615 LILLY RD NE STE 240
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5117
Practice Address - Country:US
Practice Address - Phone:360-413-3850
Practice Address - Fax:360-359-4726
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000867225XH1200X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8341299Medicaid
WA8341299Medicaid