Provider Demographics
NPI:1265588404
Name:DAHMAN, MAY R (COTA)
Entity type:Individual
Prefix:MRS
First Name:MAY
Middle Name:R
Last Name:DAHMAN
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 1:1733 KINSMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46809-1025
Mailing Address - Country:US
Mailing Address - Phone:260-615-7959
Mailing Address - Fax:
Practice Address - Street 1:1733 KINSMOOR AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46809-1025
Practice Address - Country:US
Practice Address - Phone:260-615-7959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001140A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist