Provider Demographics
NPI:1275991564
Name:DAHDAH, KARISSA (ATC)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:DAHDAH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6540 CLIFTON PARK CIR S
Mailing Address - Street 2:APT 206
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-1167
Mailing Address - Country:US
Mailing Address - Phone:614-560-5591
Mailing Address - Fax:
Practice Address - Street 1:6540 CLIFTON PARK CIR S
Practice Address - Street 2:APT 206
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-1167
Practice Address - Country:US
Practice Address - Phone:614-560-5591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0039702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer