Provider Demographics
NPI:1194498428
Name:MAYES, DANIELLE MARIE (COTA/L)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:MAYES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:MAYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA/L
Mailing Address - Street 1:601 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62681-1156
Mailing Address - Country:US
Mailing Address - Phone:217-248-4711
Mailing Address - Fax:
Practice Address - Street 1:601 N LIBERTY ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62681-1156
Practice Address - Country:US
Practice Address - Phone:217-248-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057004862224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant