Provider Demographics
NPI:1689968976
Name:LITTLE, DAWN LOUISE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:LOUISE
Last Name:LITTLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 SEVENTH DAY RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-6107
Mailing Address - Country:US
Mailing Address - Phone:601-624-4403
Mailing Address - Fax:601-891-8339
Practice Address - Street 1:210 WOODGATE DR S
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2415
Practice Address - Country:US
Practice Address - Phone:601-624-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS759225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist