Healthcare Provider Details

I. General information

NPI: 1457846842
Provider Name (Legal Business Name): NEIL MICHAEL DAAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1591 E LOHMAN AVE
LAS CRUCES NM
88001-3185
US

IV. Provider business mailing address

2502 VELARDE PL
LAS CRUCES NM
88011-4313
US

V. Phone/Fax

Practice location:
  • Phone: 575-644-6306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3851
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: