Provider Demographics
NPI:1265063812
Name:NILSEN, DAWN MARIE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MARIE
Last Name:NILSEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:MARRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:1074 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-1517
Mailing Address - Country:US
Mailing Address - Phone:845-341-3462
Mailing Address - Fax:
Practice Address - Street 1:1074 RADIO RD
Practice Address - Street 2:
Practice Address - City:LITTLE EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08087-1517
Practice Address - Country:US
Practice Address - Phone:212-342-5602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004665225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation