Provider Demographics
NPI:1710594650
Name:DAHL, SHAMAINE MA VERONICA
Entity Type:Individual
Prefix:MRS
First Name:SHAMAINE
Middle Name:MA VERONICA
Last Name:DAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 W NORRIS ST
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-9565
Mailing Address - Country:US
Mailing Address - Phone:325-977-9327
Mailing Address - Fax:
Practice Address - Street 1:106 DEL NORTE DR
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-2504
Practice Address - Country:US
Practice Address - Phone:979-543-6762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116523225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist