Provider Demographics
NPI:1053904250
Name:MYNES, DAWN (MS,OT/L)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:MYNES
Suffix:
Gender:F
Credentials:MS,OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 CARROLL RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2903
Mailing Address - Country:US
Mailing Address - Phone:443-817-2694
Mailing Address - Fax:410-729-4369
Practice Address - Street 1:715 BENFIELD RD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2210
Practice Address - Country:US
Practice Address - Phone:410-729-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06165225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist