Provider Demographics
NPI:1720338825
Name:SKELTON, DANA RAE (MS, OTR)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:RAE
Last Name:SKELTON
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N STATE RD APT 207
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1167
Mailing Address - Country:US
Mailing Address - Phone:989-395-4581
Mailing Address - Fax:
Practice Address - Street 1:1001 N STATE RD APT 207
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1167
Practice Address - Country:US
Practice Address - Phone:989-395-4581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-16
Last Update Date:2012-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007658225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist