Individual
JATIQUE DAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5535 S WILLIAMSON BLVD, STE 774, PORT ORANGE, FL 32128-8311
(800) 330-7711
Mailing address
2216 BOOKER ST, WINSTON SALEM, NC 27105-5602
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
4570
NC
225X00000X
Occupational Therapist
Primary
—
MD
Other
Enumeration date
11/04/2011
Last updated
07/31/2012
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