Healthcare Provider Details

I. General information

NPI: 1366564619
Provider Name (Legal Business Name): DAWN LYNN BECK COTAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 SOUTH 8TH
NEW ROCKFORD ND
58356-1520
US

IV. Provider business mailing address

PO BOX 486
FESSENDEN ND
58438-0486
US

V. Phone/Fax

Practice location:
  • Phone: 701-947-5015
  • Fax: 701-947-5110
Mailing address:
  • Phone: 701-547-3186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number570
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: