Provider Demographics
NPI:1750532743
Name:KOEPP, DAWN (LMT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:KOEPP
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 E POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:WI
Mailing Address - Zip Code:54822-7717
Mailing Address - Country:US
Mailing Address - Phone:717-790-8696
Mailing Address - Fax:
Practice Address - Street 1:800 WISCONSIN STREET
Practice Address - Street 2:VITAL PATHWAYS HEALING ARTS
Practice Address - City:EAU CLAIE
Practice Address - State:WI
Practice Address - Zip Code:54703-3587
Practice Address - Country:US
Practice Address - Phone:715-790-8696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3936-046225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist