Provider Demographics
NPI:1043557556
Name:MCSPADDEN, DANIEL (COTA/L)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MCSPADDEN
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 PEACEFUL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-4258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4145 MISTY MORNING WAY
Practice Address - Street 2:LANIER VILLAGE ESTATES
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506
Practice Address - Country:US
Practice Address - Phone:678-450-3035
Practice Address - Fax:770-538-6054
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001355224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant