Provider Demographics
NPI:1417000936
Name:HARVEY, DAWN MARIE (COTA)
Entity type:Individual
Prefix:MISS
First Name:DAWN
Middle Name:MARIE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50072 S ANGELO CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4644
Mailing Address - Country:US
Mailing Address - Phone:313-499-4678
Mailing Address - Fax:313-499-4367
Practice Address - Street 1:50072 S ANGELO CT
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-4644
Practice Address - Country:US
Practice Address - Phone:313-499-4678
Practice Address - Fax:313-499-4367
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202006120224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant