Provider Demographics
NPI:1184052771
Name:SPANTON, DAWN MARIE (COTA)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:SPANTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:HOLLATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:742 STERBENZ DR
Mailing Address - Street 2:ST CROIX THERAPY INC
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8327
Mailing Address - Country:US
Mailing Address - Phone:715-386-2128
Mailing Address - Fax:715-386-6119
Practice Address - Street 1:742 STERBENZ DR
Practice Address - Street 2:ST CROIX THERAPY INC
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8327
Practice Address - Country:US
Practice Address - Phone:715-386-2128
Practice Address - Fax:715-386-6119
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5054224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5054OtherWISCONSIN LICENSE