=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447538699
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAWN RAEA SANTIAGO OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2011
-----------------------------------------------------
Last Update Date | 07/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15360 LEMONADE DR
-----------------------------------------------------
City | PUNTA GORDA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-623-3914
-----------------------------------------------------
Fax | 941-505-4275
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15360 LEMONADE DR
-----------------------------------------------------
City | PUNTA GORDA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33955
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-623-3914
-----------------------------------------------------
Fax | 941-505-4275
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT5258
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------