MEDICARE: DR. DANIEL C OPDYKE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2404	NC
2	103TB0200X	Cognitive & Behavioral Psychologist	2404	NC
3	103TC0700X	Clinical Psychologist	2404	NC
4	103TC2200X	Clinical Child & Adolescent Psychologist	2404	NC
5	103TF0000X	Family Psychologist	2404	NC

General Provider Information

NPI Number	:	1215039383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL C OPDYKE PHD

Provider Business Mailing Address
First Line	:	321 7TH ST NE
Second Line	:	SUITE B
City	:	HICKORY
State	:	NC
Zip	:	28601-5113
Country	:	US
Telephone Number	:	828-485-2195
Fax Number	:	828-485-2197

Provider Business Practice Location Address
First Line	:	321 7TH ST NE
Second Line	:	SUITE B
City	:	HICKORY
State	:	NC
Zip	:	28601-5113
Country	:	US
Telephone Number	:	828-485-2195
Fax Number	:	828-485-2197

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	09/17/2008

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