Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003367897 |
---|---|
Provider Name | Scott Mcdaniel |
First Address | Bonaire, GA 31005-3663 |
Second Address | Bonaire, GA 31005-3663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2016 |
Last Update Date | 19/11/2021 |