Provider Demographics
NPI:1275809790
Name:MITCHELL, DANIEL JAMES (OTR)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JAMES
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 WEST SHORE TRAIL
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1624
Mailing Address - Country:US
Mailing Address - Phone:973-729-8989
Mailing Address - Fax:
Practice Address - Street 1:99 MULFORD RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07821-2600
Practice Address - Country:US
Practice Address - Phone:973-383-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00174800225X00000X
PAOC-004588-L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist