Provider Demographics
NPI:1265723100
Name:MCDANIEL, TARA REVEE (MS, OTR/L)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:REVEE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8358 ATTALLA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-6702
Mailing Address - Country:US
Mailing Address - Phone:941-467-6972
Mailing Address - Fax:
Practice Address - Street 1:6343 VIA DE SONRISA DEL SUR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-8211
Practice Address - Country:US
Practice Address - Phone:561-391-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6490225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist