Provider Demographics
NPI:1588408645
Name:MCDANIEL, CASEY BECK (MS OT)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:BECK
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MS OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 KENDUSKEAG AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3805
Mailing Address - Country:US
Mailing Address - Phone:207-491-0254
Mailing Address - Fax:
Practice Address - Street 1:5 LONG LN STE 2
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1734
Practice Address - Country:US
Practice Address - Phone:208-619-1172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT4658225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist