Healthcare Provider Details

I. General information

NPI: 1780803890
Provider Name (Legal Business Name): DAWN BJORNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16632 S 35TH ST
PHOENIX AZ
85048-7847
US

IV. Provider business mailing address

16632 S 35TH ST
PHOENIX AZ
85048-7847
US

V. Phone/Fax

Practice location:
  • Phone: 480-704-6534
  • Fax:
Mailing address:
  • Phone: 480-704-6534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2889
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: