Provider Demographics
NPI:1720236714
Name:DAHL, CHERILYN RAE (OTR)
Entity Type:Individual
Prefix:
First Name:CHERILYN
Middle Name:RAE
Last Name:DAHL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E208 N BUFFALO CT
Mailing Address - Street 2:
Mailing Address - City:NELSON
Mailing Address - State:WI
Mailing Address - Zip Code:54756-8410
Mailing Address - Country:US
Mailing Address - Phone:715-673-4444
Mailing Address - Fax:
Practice Address - Street 1:E208 N BUFFALO CT
Practice Address - Street 2:
Practice Address - City:NELSON
Practice Address - State:WI
Practice Address - Zip Code:54756-8410
Practice Address - Country:US
Practice Address - Phone:715-673-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3892-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist