Provider Demographics
NPI:1225508740
Name:BERTHIAUME, DANA M (EDD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:M
Last Name:BERTHIAUME
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 W TOWNLINE RD # 14
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MI
Mailing Address - Zip Code:48611-9738
Mailing Address - Country:US
Mailing Address - Phone:989-891-6384
Mailing Address - Fax:
Practice Address - Street 1:132 W. TOWNLINE 14
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MI
Practice Address - Zip Code:48611-4861
Practice Address - Country:US
Practice Address - Phone:989-891-6384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004540225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist