MEDICARE: MS. DAWN ELIZABETH WHALEN OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	6820	MA

General Provider Information

NPI Number	:	1336321652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAWN ELIZABETH WHALEN OT

Provider Business Mailing Address
First Line	:	255 HIGHLAND AVE
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02494-3023
Country	:	US
Telephone Number	:	781-449-1884
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 HIGHLAND AVE
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02494-3023
Country	:	US
Telephone Number	:	781-449-1884
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	11/28/2007

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