Provider Demographics
NPI:1821813874
Name:LEVINE, DAWN MICHELE (LMT, COMT, CMLDT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELE
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LMT, COMT, CMLDT
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MICHELE
Other - Last Name:STOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, COMT, CMLDT
Mailing Address - Street 1:22 MEADOWBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2313
Mailing Address - Country:US
Mailing Address - Phone:732-546-6282
Mailing Address - Fax:
Practice Address - Street 1:22 MEADOWBROOK AVE
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2313
Practice Address - Country:US
Practice Address - Phone:732-546-6282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00988100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty