Healthcare Provider Details

I. General information

NPI: 1649483025
Provider Name (Legal Business Name): DAWN LADUKE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 CREEKSIDE CIR APT B
ELGIN IL
60123-1110
US

IV. Provider business mailing address

2721 FOX HOLLOW CT
LAKE ORION MI
48360-1717
US

V. Phone/Fax

Practice location:
  • Phone: 207-491-2219
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0119004769
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31004437A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201004890
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number05793
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: