Provider Demographics
NPI:1073622650
Name:TELLMAN, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:TELLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4781 LOWER ELKTON RD
Mailing Address - Street 2:
Mailing Address - City:LEETONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44431-9632
Mailing Address - Country:US
Mailing Address - Phone:330-482-0620
Mailing Address - Fax:
Practice Address - Street 1:2614 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6204
Practice Address - Country:US
Practice Address - Phone:330-394-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPT-10911OtherLICENSE #