Provider Demographics
NPI:1093257404
Name:KITTLESON, DAWN (OTR)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:KITTLESON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16600 W SPRAGUE RD STE 365
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6319
Mailing Address - Country:US
Mailing Address - Phone:216-227-7700
Mailing Address - Fax:
Practice Address - Street 1:2319 7TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-2813
Practice Address - Country:US
Practice Address - Phone:651-251-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105147225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist