Healthcare Provider Details

I. General information

NPI: 1700275450
Provider Name (Legal Business Name): ROSS DANIEL MCDONELL MOT, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 1ST ST
SPOONER WI
54801-1241
US

IV. Provider business mailing address

4210 CEDAR AVE
SCHOFIELD WI
54476-2733
US

V. Phone/Fax

Practice location:
  • Phone: 715-635-3466
  • Fax: 715-635-7498
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5260
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number26-5260
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: