Provider Demographics
NPI:1053991026
Name:BEAUCHEMIN, DAKOTA (BS)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:
Last Name:BEAUCHEMIN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 FERGASON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5543
Mailing Address - Country:US
Mailing Address - Phone:727-410-3135
Mailing Address - Fax:
Practice Address - Street 1:1303 FERGASON AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5543
Practice Address - Country:US
Practice Address - Phone:727-410-3135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist