Provider Demographics
NPI:1760360390
Name:DANIEL, TANNER AVERY
Entity type:Individual
Prefix:MR
First Name:TANNER
Middle Name:AVERY
Last Name:DANIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W ILLINOIS ST UNIT 102
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-1301
Mailing Address - Country:US
Mailing Address - Phone:618-383-6459
Mailing Address - Fax:
Practice Address - Street 1:9355 WARRICK TRL
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-0015
Practice Address - Country:US
Practice Address - Phone:812-476-9983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99132479A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist