Provider Demographics
NPI:1508562299
Name:DECATOR, DAWN (LMT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:DECATOR
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 1:321 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-1638
Mailing Address - Country:US
Mailing Address - Phone:269-685-5486
Mailing Address - Fax:269-685-9711
Practice Address - Street 1:321 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1638
Practice Address - Country:US
Practice Address - Phone:269-685-5486
Practice Address - Fax:269-685-9711
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI22238040801225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist