Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 31002319A | IN |
NPI | 1932782695 |
---|---|
Provider Name | Mr. Daniel Dean Mckinzie |
First Address | Brownsburg, IN 46112-7994 |
Second Address | Brownsburg, IN 46112-7994 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2021 |
Last Update Date | 30/04/2021 |