Provider Demographics
NPI:1184899742
Name:MCDANIEL, JENNIFER IRENE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:IRENE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 WOODMONT CT
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-7161
Mailing Address - Country:US
Mailing Address - Phone:530-844-0838
Mailing Address - Fax:
Practice Address - Street 1:845 WOODMONT CT
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-7161
Practice Address - Country:US
Practice Address - Phone:530-844-0838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5317225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5317OtherCALIFORNIA BOARD OF CONSUMER AFFAIRS - OT LICENSE