Provider Demographics
NPI:1932782695
Name:MCKINZIE, DANIEL DEAN (OTR, MPP)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:DEAN
Last Name:MCKINZIE
Suffix:
Gender:M
Credentials:OTR, MPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 MIKAL LN
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7994
Mailing Address - Country:US
Mailing Address - Phone:317-313-3239
Mailing Address - Fax:
Practice Address - Street 1:833 MIKAL LN
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7994
Practice Address - Country:US
Practice Address - Phone:317-313-3239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002319A225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Single Specialty