Provider Demographics
NPI:1366564619
Name:BECK, DAWN LYNN (COTAL)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:LYNN
Last Name:BECK
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:FESSENDEN
Mailing Address - State:ND
Mailing Address - Zip Code:58438-0486
Mailing Address - Country:US
Mailing Address - Phone:701-547-3186
Mailing Address - Fax:
Practice Address - Street 1:16 SOUTH 8TH
Practice Address - Street 2:
Practice Address - City:NEW ROCKFORD
Practice Address - State:ND
Practice Address - Zip Code:58356-1520
Practice Address - Country:US
Practice Address - Phone:701-947-5015
Practice Address - Fax:701-947-5110
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND570224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant