Provider Demographics
NPI:1467661736
Name:MAINES, DANIEL EDWIN (OT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:EDWIN
Last Name:MAINES
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 CALVARY LN
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-7977
Mailing Address - Country:US
Mailing Address - Phone:814-938-4471
Mailing Address - Fax:
Practice Address - Street 1:786 CALVARY LN
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-7977
Practice Address - Country:US
Practice Address - Phone:814-938-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006329L171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor