Provider Demographics
NPI:1598188013
Name:MENDOZA, DAWN (OTR/L)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:MENDOZA
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 1:1670 HIGHWAY 160 W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8063
Mailing Address - Country:US
Mailing Address - Phone:803-230-8902
Mailing Address - Fax:803-547-9706
Practice Address - Street 1:1670 HIGHWAY 160 W
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8063
Practice Address - Country:US
Practice Address - Phone:803-230-8902
Practice Address - Fax:803-547-9706
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4241225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist