Provider Demographics
NPI:1396890588
Name:DAHLEN, ROSE (OTR-L)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:DAHLEN
Suffix:
Gender:F
Credentials:OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 CREEK HOLLOW RUN
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-2304
Mailing Address - Country:US
Mailing Address - Phone:662-313-5027
Mailing Address - Fax:
Practice Address - Street 1:1122 N ESHMAN AVE
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-5436
Practice Address - Country:US
Practice Address - Phone:662-494-6011
Practice Address - Fax:662-492-0065
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1781225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist