Provider Demographics
NPI:1588965701
Name:MACK, DANIEL CHRISTOPHER (OTR)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:CHRISTOPHER
Last Name:MACK
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 SOUTHFIELD CT
Mailing Address - Street 2:
Mailing Address - City:FINKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21048-2256
Mailing Address - Country:US
Mailing Address - Phone:410-259-6622
Mailing Address - Fax:410-526-2332
Practice Address - Street 1:2340 SOUTHFIELD CT
Practice Address - Street 2:
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-2256
Practice Address - Country:US
Practice Address - Phone:410-259-6622
Practice Address - Fax:410-526-2332
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03276225X00000X, 225XE0001X, 225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental Modification
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology