Provider Demographics
NPI:1497435697
Name:DANIELS, MICHELLE (OT, MSOT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:OT, MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SEDGEWICK DR
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-1437
Mailing Address - Country:US
Mailing Address - Phone:781-248-5269
Mailing Address - Fax:
Practice Address - Street 1:107 SEDGEWICK DR
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-1437
Practice Address - Country:US
Practice Address - Phone:781-248-5269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOTL2160225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist