Provider Demographics
NPI:1710642210
Name:MCDANIEL, SARAH JENNINGS (OTR/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JENNINGS
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:230 ABBEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-5103
Mailing Address - Country:US
Mailing Address - Phone:478-893-6544
Mailing Address - Fax:
Practice Address - Street 1:111 PROVIDENCE BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-7550
Practice Address - Country:US
Practice Address - Phone:478-250-9154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008231225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist