Provider Demographics
NPI:1346544814
Name:SPIEKERMAN, DAWN BARBARA (LMT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:BARBARA
Last Name:SPIEKERMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 WALBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-5561
Mailing Address - Country:US
Mailing Address - Phone:216-526-9235
Mailing Address - Fax:
Practice Address - Street 1:23131 EMERY RD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5136
Practice Address - Country:US
Practice Address - Phone:216-514-9590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.007953305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDBS9235Medicaid