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NPI Code Detail

MEDICARE: SHELLY SUZANNE MCDANIEL OTR

MEDICARE: SHELLY SUZANNE MCDANIEL OTR
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
1225X00000XOccupational Therapist2725CO

General Provider Information

NPI Number : 1457673220
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLY SUZANNE MCDANIEL OTR
Provider Business Mailing Address
First Line : 1711 WOODMOOR DR
Second Line :
City : MONUMENT
State : CO
Zip : 80132-9002
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12105 AMBASSADOR DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80921-3642
Country : US
Telephone Number : 719-481-5161
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2010
Last Update Date : 02/22/2010

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