=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528308863
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAWN MARIE EINFELDT OTA6429
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2013
-----------------------------------------------------
Last Update Date | 02/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1430 ISLAND DR S APT/SUITE
-----------------------------------------------------
City | SOUTH PASADENA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33707-3714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-560-4624
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1430 ISLAND DR S APT/SUITE
-----------------------------------------------------
City | SOUTH PASADENA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33707-3714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-560-4624
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224Z00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapy Assistant
-----------------------------------------------------
License Number | OTA6429
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------