=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568945335
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VALERIE DUNN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2018
-----------------------------------------------------
Last Update Date | 08/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1846 INTERSTATE 10 S STE 102
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77707-4440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-607-9492
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 57
-----------------------------------------------------
City | BUCYRUS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65444-0057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-260-0316
-----------------------------------------------------
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 |
-----------------------------------------------------
License Number State |
-----------------------------------------------------