Provider Demographics
NPI:1437307642
Name:MCDANIEL, FREDERICK OLIN JR (OT)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:OLIN
Last Name:MCDANIEL
Suffix:JR
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 EARLY ST. STE G
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1680
Mailing Address - Country:US
Mailing Address - Phone:505-992-1088
Mailing Address - Fax:
Practice Address - Street 1:825 EARLY ST STE G
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1680
Practice Address - Country:US
Practice Address - Phone:505-992-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM985225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist