Provider Demographics
NPI:1225436405
Name:DAWES, MONIQUE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:DAWES
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1714
Mailing Address - Country:US
Mailing Address - Phone:339-364-9846
Mailing Address - Fax:
Practice Address - Street 1:19 HENRY ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1714
Practice Address - Country:US
Practice Address - Phone:339-364-9846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07490225X00000X
IL056.010836225X00000X
MA10292225X00000X
NY018147-1225X00000X
CA14789225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist