Healthcare Provider Details

I. General information

NPI: 1407086556
Provider Name (Legal Business Name): DANIEL MILLS JR. OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 OSPREY VILLAGE DR
AMELIA ISLAND FL
32034-4962
US

IV. Provider business mailing address

76 OSPREY VILLAGE DR
AMELIA ISLAND FL
32034-4962
US

V. Phone/Fax

Practice location:
  • Phone: 904-491-1701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT9699
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: