Provider Demographics
NPI:1417426453
Name:FRESE, DAWN (OTR)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:FRESE
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 1:905 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-1677
Mailing Address - Country:US
Mailing Address - Phone:269-684-1944
Mailing Address - Fax:269-683-6888
Practice Address - Street 1:905 N FRONT ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-1677
Practice Address - Country:US
Practice Address - Phone:269-684-1944
Practice Address - Fax:269-683-6888
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201004384225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist