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NPI Code Detail

MEDICARE: DARYL ALLDER

MEDICARE: DARYL ALLDER
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
1224Z00000XOccupational Therapy Assistant0131001202VA
2224Z00000XOccupational Therapy AssistantOTA4558NM

General Provider Information

NPI Number : 1972912863
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARYL ALLDER
Provider Business Mailing Address
First Line : 5760 PENGUIN DR
Second Line :
City : ROANOKE
State : VA
Zip : 24018-4815
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3514 N FOWLER AVE
Second Line :
City : SILVER CITY
State : NM
Zip : 88061-7210
Country : US
Telephone Number : 575-388-3127
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2014
Last Update Date : 10/12/2022

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