Provider Demographics
NPI:1861656472
Name:MCCLAIN, DANIELLE NICHOLE (COTA/L)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NICHOLE
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4919 CELESTE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-1290
Mailing Address - Country:US
Mailing Address - Phone:502-290-7988
Mailing Address - Fax:
Practice Address - Street 1:4919 CELESTE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40228-1290
Practice Address - Country:US
Practice Address - Phone:502-290-7988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-13
Last Update Date:2008-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-A3765224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant