Provider Demographics
NPI:1104981836
Name:MCDANIEL, LINWOOD A JR (OT)
Entity type:Individual
Prefix:MR
First Name:LINWOOD
Middle Name:A
Last Name:MCDANIEL
Suffix:JR
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 1:4048 KINGSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-7501
Mailing Address - Country:US
Mailing Address - Phone:619-550-6288
Mailing Address - Fax:
Practice Address - Street 1:3602 W SAN JUAN ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-6922
Practice Address - Country:US
Practice Address - Phone:619-550-6288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21635225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist