Provider Demographics
NPI:1457443715
Name:MAHONEY, DARCI (OTR)
Entity Type:Individual
Prefix:
First Name:DARCI
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:DARCI
Other - Middle Name:
Other - Last Name:FREDRICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456-2014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:216 SUNSET PL
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-1706
Practice Address - Country:US
Practice Address - Phone:763-689-5385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1587225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN411G1MAOtherBCBS
WI41810700Medicaid
MN6406050OtherMEDICA
MNHP55737OtherHP55737
MNHP55737OtherHP55737