Provider Demographics
NPI:1447377734
Name:PELAEZ, DANIEL (OTR L)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:PELAEZ
Suffix:
Gender:M
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 1:126 SCHOOLHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1035
Mailing Address - Country:US
Mailing Address - Phone:856-273-9897
Mailing Address - Fax:
Practice Address - Street 1:126 SCHOOLHOUSE LN
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1035
Practice Address - Country:US
Practice Address - Phone:856-273-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00177100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist