Provider Demographics
NPI:1902993736
Name:DANIELSON, TARA (OTR)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 THORNBURG PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-8010
Mailing Address - Country:US
Mailing Address - Phone:317-852-7641
Mailing Address - Fax:317-858-1292
Practice Address - Street 1:355 THORNBURG PARKWAY
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-8010
Practice Address - Country:US
Practice Address - Phone:317-852-7641
Practice Address - Fax:317-858-1292
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000903A225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics