Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 03276 | MD |
N | 225XE0001X | Environmental Modification | 03276 | MD |
N | 225XG0600X | Occupational Therapist - Gerontology | 03276 | MD |
NPI | 1588965701 |
---|---|
Provider Name | Mr. Daniel Christopher Mack |
First Address | Finksburg, MD 21048-2256 |
Second Address | Finksburg, MD 21048-2256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2010 |
Last Update Date | 04/11/2010 |