Provider Demographics
NPI:1891015236
Name:BLAKE, DAWN K (OT)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:K
Last Name:BLAKE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1379
Mailing Address - Street 2:
Mailing Address - City:PUUNENE
Mailing Address - State:HI
Mailing Address - Zip Code:96784-1379
Mailing Address - Country:US
Mailing Address - Phone:808-873-7700
Mailing Address - Fax:808-873-7100
Practice Address - Street 1:244 PAPA PL
Practice Address - Street 2:SUITE 102
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2988
Practice Address - Country:US
Practice Address - Phone:808-873-7700
Practice Address - Fax:808-873-7100
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI222225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics