Provider Demographics
NPI:1518094473
Name:DAWSON, EVA LOUISE (OTR)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:LOUISE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:EVA
Other - Middle Name:LOUISE
Other - Last Name:DELSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2115 W LOUISE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2115 W LOUISE ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5808
Practice Address - Country:US
Practice Address - Phone:308-850-5117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1125225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025372600Medicaid
NE02100OtherBLUE CROSS BLUE SHIELD