Provider Demographics
NPI:1306499173
Name:VIGUE, DAWN THERESA (OTR)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:THERESA
Last Name:VIGUE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:DAWN
Other - Middle Name:THERESA
Other - Last Name:VIGUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DAWN VIGUE, OTR/L
Mailing Address - Street 1:21626 STONEWALL PKWY APT 4402
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-1724
Mailing Address - Country:US
Mailing Address - Phone:860-995-3766
Mailing Address - Fax:
Practice Address - Street 1:21626 STONEWALL PKWY APT 4402
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-1724
Practice Address - Country:US
Practice Address - Phone:860-995-3766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119983225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist