Provider Demographics
NPI:1275733032
Name:BAZAN, DAWN M (MS,OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:M
Last Name:BAZAN
Suffix:
Gender:F
Credentials:MS,OTR/L
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Other - Credentials:
Mailing Address - Street 1:106 MONTCALM ST
Mailing Address - Street 2:NORTHWOODS WELLNESS PHYSICAL & OCCUPATIONAL THERAPY
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-4101
Mailing Address - Country:US
Mailing Address - Phone:518-585-9285
Mailing Address - Fax:518-585-9286
Practice Address - Street 1:106 MONTCALM ST
Practice Address - Street 2:NORTHWOODS WELLNESS PHYSICAL & OCCUPATIONAL THERAPY
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-1353
Practice Address - Country:US
Practice Address - Phone:518-585-9285
Practice Address - Fax:518-585-9286
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1598948259225100000X
NY1679756332225100000X
NY007563-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist