Provider Demographics
NPI:1821324393
Name:DAWSON, KRISTIN WICKMAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:WICKMAN
Last Name:DAWSON
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 1:1774 WINFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-2478
Mailing Address - Country:US
Mailing Address - Phone:727-224-3934
Mailing Address - Fax:
Practice Address - Street 1:1774 WINFIELD CIR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-2478
Practice Address - Country:US
Practice Address - Phone:727-224-3934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 3097225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics