Provider Demographics
NPI:1083918882
Name:FISKE, DAWN THERESA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:THERESA
Last Name:FISKE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1109 PINELLAS BAYWAY S
Mailing Address - Street 2:UNIT 308
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33715-2173
Mailing Address - Country:US
Mailing Address - Phone:727-954-3276
Mailing Address - Fax:
Practice Address - Street 1:1109 PINELLAS BAYWAY S
Practice Address - Street 2:UNIT 308
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33715-2173
Practice Address - Country:US
Practice Address - Phone:727-954-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT374225X00000X
FLOT13730225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist