Individual
DANIEL LEE PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
3905 W ERNESTINE DR, SUITE B, MARION, IL 62959-5800
(618) 993-6237
Mailing address
3905 W ERNESTINE DR, SUITE B, MARION, IL 62959-5800
(618) 993-6237
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056009406
IL
225X00000X
Occupational Therapist
R4859
KY
Other
Enumeration date
07/11/2011
Last updated
12/13/2011
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