MEDICARE: DOMINIQUE MCDANIEL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	172A00000X	Driver
2	173000000X	Legal Medicine	OH
3	174200000X	Meals Provider	OH
4	347C00000X	Private Vehicle	OH
5	251C00000X	Developmentally Disabled Services Day Training Agency	OH
6	251E00000X	Home Health Agency
7	261QA0600X	Adult Day Care Clinic/Center	OH
8	261QD1600X	Developmental Disabilities Clinic/Center
9	372600000X	Adult Companion

General Provider Information

NPI Number	:	1609601566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE MCDANIEL

Provider Business Mailing Address
First Line	:	1013 PARDEE AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-2013
Country	:	US
Telephone Number	:	440-319-9106
Fax Number	:

Provider Business Practice Location Address
First Line	:	1013 PARDEE AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44306-2013
Country	:	US
Telephone Number	:	440-319-9106
Fax Number	:

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

Provider Enumeration Date	:	09/02/2024
Last Update Date	:	09/02/2024

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Directions to “ DOMINIQUE MCDANIEL ” Practice Location

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