Provider Demographics
NPI:1285441600
Name:WALLER, DANIEL ANDREW
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ANDREW
Last Name:WALLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2440
Mailing Address - Country:US
Mailing Address - Phone:330-361-0550
Mailing Address - Fax:
Practice Address - Street 1:606 7TH ST NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-2440
Practice Address - Country:US
Practice Address - Phone:330-361-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services