Provider Demographics
NPI:1528219516
Name:DEPKE, DAWN (BA, OBT, NCBTMB)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:DEPKE
Suffix:
Gender:F
Credentials:BA, OBT, NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 QUAIL ST
Mailing Address - Street 2:106
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2729
Mailing Address - Country:US
Mailing Address - Phone:630-441-8183
Mailing Address - Fax:
Practice Address - Street 1:1300 QUAIL ST
Practice Address - Street 2:106
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2729
Practice Address - Country:US
Practice Address - Phone:630-441-8183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
289794-00OtherNCBTMB