Provider Demographics
NPI:1215269840
Name:DASCOMB, DIERDRE LYNNE
Entity type:Individual
Prefix:MS
First Name:DIERDRE
Middle Name:LYNNE
Last Name:DASCOMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77B S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-1225
Mailing Address - Country:US
Mailing Address - Phone:814-725-3098
Mailing Address - Fax:
Practice Address - Street 1:77B S PEARL ST
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428-1225
Practice Address - Country:US
Practice Address - Phone:814-725-3098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-07
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist