Healthcare Provider Details

I. General information

NPI: 1568597730
Provider Name (Legal Business Name): DAWN KAREN VANNATTA MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5008 OLD CASK WAY
APEX NC
27502-8957
US

IV. Provider business mailing address

5008 OLD CASK WAY
APEX NC
27502-8957
US

V. Phone/Fax

Practice location:
  • Phone: 919-632-4995
  • Fax:
Mailing address:
  • Phone: 919-632-4995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3696
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7302148
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: