Provider Demographics
NPI:1730420928
Name:O'DANIELS, DENISE HENRIETTE (COTA)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:HENRIETTE
Last Name:O'DANIELS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WINONA LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46590-1638
Mailing Address - Country:US
Mailing Address - Phone:574-267-8160
Mailing Address - Fax:
Practice Address - Street 1:1801 PARK AVE
Practice Address - Street 2:
Practice Address - City:WINONA LAKE
Practice Address - State:IN
Practice Address - Zip Code:46590-1638
Practice Address - Country:US
Practice Address - Phone:574-267-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002338A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant