Provider Demographics
NPI:1043359581
Name:PELINO, DAWN LOUISE (OTR, CHT)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:LOUISE
Last Name:PELINO
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21906 JURICNY DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-4631
Mailing Address - Country:US
Mailing Address - Phone:248-620-8980
Mailing Address - Fax:248-620-9397
Practice Address - Street 1:5825 S MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2983
Practice Address - Country:US
Practice Address - Phone:248-620-8980
Practice Address - Fax:248-620-9397
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005409225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist