Provider Demographics
NPI:1225500606
Name:DANISON, MIKALYNN MARY (COTA/L)
Entity Type:Individual
Prefix:
First Name:MIKALYNN
Middle Name:MARY
Last Name:DANISON
Suffix:
Gender:F
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:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:PHILO
Mailing Address - State:OH
Mailing Address - Zip Code:43771-0182
Mailing Address - Country:US
Mailing Address - Phone:740-819-9147
Mailing Address - Fax:
Practice Address - Street 1:957 BECKS KNOB RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8800
Practice Address - Country:US
Practice Address - Phone:740-654-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-22
Last Update Date:2018-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA007203224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant