Healthcare Provider Details

I. General information

NPI: 1376460402
Provider Name (Legal Business Name): DAWN LAFONTAINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8389 ELLIS RD
PASS CHRISTIAN MS
39571-8112
US

IV. Provider business mailing address

8389 ELLIS RD
PASS CHRISTIAN MS
39571-8112
US

V. Phone/Fax

Practice location:
  • Phone: 229-216-9462
  • Fax:
Mailing address:
  • Phone: 229-216-9462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3945
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: