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General NPI Number Information
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NPI Number | 1700275450
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Entity Type | Individual
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Provider Name | ROSS DANIEL MCDONELL MOT, OTR/L
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Gender | Male
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Dates
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Enumeration Date | 01/19/2015
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 510 1ST ST
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City | SPOONER
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State | WI
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Zip | 54801-1241
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Country | US
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Telephone | 715-635-3466
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Fax | 715-635-7498
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Provider Business Mailing Address
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Address Line | 4210 CEDAR AVE
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City | SCHOFIELD
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State | WI
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Zip | 54476-2733
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5260
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 26-5260
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License Number State | WI
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