Provider Demographics
NPI:1417303587
Name:STEVENS, DAWN M (LMT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:STEVENS
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 1:184 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2817
Mailing Address - Country:US
Mailing Address - Phone:207-570-9933
Mailing Address - Fax:207-764-8118
Practice Address - Street 1:184 MAIN ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2817
Practice Address - Country:US
Practice Address - Phone:207-570-9933
Practice Address - Fax:207-764-8118
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT2483225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist