Provider Demographics
NPI:1447656053
Name:GREGG, DANIEL T (MS OTR/L)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:GREGG
Suffix:
Gender:M
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 1:413 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-7401
Mailing Address - Country:US
Mailing Address - Phone:712-301-8743
Mailing Address - Fax:
Practice Address - Street 1:4725 MERLE HAY RD
Practice Address - Street 2:#107
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-1983
Practice Address - Country:US
Practice Address - Phone:515-331-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072338225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist