Provider Demographics
NPI:1063951358
Name:DANIELS, REBECCA SUE (COTA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 JUSTIN MORRILL MEM HWY
Mailing Address - Street 2:PO BOX 93
Mailing Address - City:SOUTH STRAFFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05070-7709
Mailing Address - Country:US
Mailing Address - Phone:802-765-4936
Mailing Address - Fax:
Practice Address - Street 1:80 LYME RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-1225
Practice Address - Country:US
Practice Address - Phone:603-277-9563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0341224Z00000X
VT073.0000144224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant