Provider Demographics
NPI:1528481116
Name:UNTIED, DARCI (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:DARCI
Middle Name:
Last Name:UNTIED
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 MARTINSBURG RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-4225
Mailing Address - Country:US
Mailing Address - Phone:740-393-2933
Mailing Address - Fax:
Practice Address - Street 1:308 MARTINSBURG RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-4225
Practice Address - Country:US
Practice Address - Phone:740-393-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7056225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist