MEDICARE: DAWN PARKS

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1356049092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN PARKS

Provider Business Mailing Address
First Line	:	7108 SOUTH KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Provider Business Practice Location Address
First Line	:	7544 MANAKIN PL
Second Line	:
City	:	INDIAN LAND
State	:	SC
Zip	:	29707-5921
Country	:	US
Telephone Number	:	818-391-3224
Fax Number	:

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

Provider Enumeration Date	:	02/22/2023
Last Update Date	:	03/04/2023

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Directions to “ DAWN PARKS ” Practice Location

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