Provider Demographics
NPI:1528476918
Name:MCDANIEL, ALIVIA (COTA/L)
Entity type:Individual
Prefix:
First Name:ALIVIA
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 GLENDALE ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4455
Mailing Address - Country:US
Mailing Address - Phone:870-333-2600
Mailing Address - Fax:870-932-3611
Practice Address - Street 1:1900 STILLWATER DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9119
Practice Address - Country:US
Practice Address - Phone:870-932-3600
Practice Address - Fax:870-932-3611
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR224Z00000X, 224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant