Provider Demographics
NPI:1124216833
Name:MCDADE, DANA PATRICE (OTR)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:PATRICE
Last Name:MCDADE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17636 GREENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3586
Mailing Address - Country:US
Mailing Address - Phone:313-673-7730
Mailing Address - Fax:
Practice Address - Street 1:4215 JOE RAMSEY BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401
Practice Address - Country:US
Practice Address - Phone:903-408-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112356225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist