Provider Demographics
NPI:1629118732
Name:HARPER, DAWN M (OTA)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:HARPER
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 KELLER AVE N
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-1036
Mailing Address - Country:US
Mailing Address - Phone:715-268-1001
Mailing Address - Fax:715-268-1002
Practice Address - Street 1:220 KELLER AVE N
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1036
Practice Address - Country:US
Practice Address - Phone:715-268-1001
Practice Address - Fax:715-268-1002
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1913224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1913OtherSTATE LICENSE