Provider Demographics
NPI:1386981843
Name:WHEATON, DAWN RACHELE (OTR/L)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:RACHELE
Last Name:WHEATON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:RACHELE
Other - Last Name:VAN SICKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 N EAST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1753
Mailing Address - Country:US
Mailing Address - Phone:517-205-4704
Mailing Address - Fax:
Practice Address - Street 1:1001 LAURENCE AVE STE B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202
Practice Address - Country:US
Practice Address - Phone:517-750-4777
Practice Address - Fax:517-782-4717
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201005567225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist