Provider Demographics
NPI:1083121743
Name:CHIDEBELL, DAWN M (MM, MT-BC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:CHIDEBELL
Suffix:
Gender:F
Credentials:MM, MT-BC
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:PUFAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MM, MT-BC
Mailing Address - Street 1:2796 CORBUSIER DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8606
Mailing Address - Country:US
Mailing Address - Phone:321-480-9373
Mailing Address - Fax:
Practice Address - Street 1:2796 CORBUSIER DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8606
Practice Address - Country:US
Practice Address - Phone:321-480-9373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist