Provider Demographics
NPI:1790826428
Name:LEVESQUE, DAWN (OTRL)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 PILOT KNOB RD 100
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1930
Mailing Address - Country:US
Mailing Address - Phone:651-994-9644
Mailing Address - Fax:
Practice Address - Street 1:2795 PILOT KNOB RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1119
Practice Address - Country:US
Practice Address - Phone:651-994-9644
Practice Address - Fax:651-994-8962
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101196225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN961S2KUOtherBCBS
MNHP34806OtherHEALTH PARTNERS
MN196211600Medicaid
MN6402176OtherMEDICA