Provider Demographics
NPI:1407297526
Name:SPENCE, DAWN M (OTR)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:SPENCE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N8W33828 FOREST RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2412
Mailing Address - Country:US
Mailing Address - Phone:262-646-8254
Mailing Address - Fax:
Practice Address - Street 1:N8W33828 FOREST RIDGE RD
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2412
Practice Address - Country:US
Practice Address - Phone:262-646-8254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2464-64225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist