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General NPI Number Information
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NPI Number | 1043557556
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Entity Type | Individual
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Provider Name | DANIEL MCSPADDEN COTA/L
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Gender | Male
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Dates
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Enumeration Date | 01/04/2013
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Last Update Date | 01/04/2013
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Provider Practice Location Address
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Address Line | 4145 MISTY MORNING WAY LANIER VILLAGE ESTATES
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City | GAINESVILLE
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State | GA
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Zip | 30506
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Country | US
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Telephone | 678-450-3035
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Fax | 770-538-6054
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Provider Business Mailing Address
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Address Line | 987 PEACEFUL VALLEY DR
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City | CLEVELAND
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State | GA
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Zip | 30528-4258
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA001355
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License Number State | GA
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