Provider Demographics
NPI:1528233590
Name:FAULKNER, DAWN ILENE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:ILENE
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42W790 CLOVER HILL LN
Mailing Address - Street 2:
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-8444
Mailing Address - Country:US
Mailing Address - Phone:630-712-4663
Mailing Address - Fax:
Practice Address - Street 1:42W790 CLOVER HILL LN
Practice Address - Street 2:
Practice Address - City:ELBURN
Practice Address - State:IL
Practice Address - Zip Code:60119-8444
Practice Address - Country:US
Practice Address - Phone:630-712-4663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056000498225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist