Provider Demographics
NPI:1568597730
Name:VANNATTA, DAWN KAREN (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:KAREN
Last Name:VANNATTA
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 OLD CASK WAY
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-8957
Mailing Address - Country:US
Mailing Address - Phone:919-632-4995
Mailing Address - Fax:
Practice Address - Street 1:5008 OLD CASK WAY
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-8957
Practice Address - Country:US
Practice Address - Phone:919-632-4995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3696225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7302148Medicaid