Provider Demographics
NPI:1700275450
Name:MCDONELL, ROSS DANIEL (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:DANIEL
Last Name:MCDONELL
Suffix:
Gender:M
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-2733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:510 1ST ST
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-1241
Practice Address - Country:US
Practice Address - Phone:715-635-3466
Practice Address - Fax:715-635-7498
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-19
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5260225X00000X
WI26-5260225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist