Provider Demographics
NPI:1316581523
Name:SUTHERLIN, DAWN MARIE
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:SUTHERLIN
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 1:6908 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KEWADIN
Mailing Address - State:MI
Mailing Address - Zip Code:49648-9333
Mailing Address - Country:US
Mailing Address - Phone:734-752-3223
Mailing Address - Fax:
Practice Address - Street 1:6908 BIRCHWOOD DR
Practice Address - Street 2:
Practice Address - City:KEWADIN
Practice Address - State:MI
Practice Address - Zip Code:49648-9333
Practice Address - Country:US
Practice Address - Phone:734-752-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501002420225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist