Dawn Lee Rudolph, OTR/L

Primary specialty

Gerontology Occupational TherapistTaxonomy code 225XG0600X

License

OT9361 Issued in FL

Practice address

4745 Sutton Park CT Ste 403
Jacksonville, FL 32224-0255

Phone

(904) 371-4649

NPI assigned

Aug 4, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Revive Rehab IncGroup PAC ID 8527197441, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Revive Rehab Inc

  • Physical Therapist
  • Jacksonville, FL
  • NPI 1962734210
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596499200000",
    "number": "1437769478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "896 MARSHSIDE CT",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322502696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4745 SUTTON PARK CT STE 403",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322240255",
            "telephone_number": "904-371-4649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "DAWN",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-04",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XG0600X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Gerontology",
            "state": "FL",
            "license": "OT9361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Shivel Rudd, CRNA
• Lauren Nicole Rudder, BSN, RN
• Rudella'S Total Health and Wellness Center
• Rebecca Elizabeth Rudisill, PT, DPT
• Leona Rudnicki-Roberts, MA
• Brandon Rudy, CRNA
• Lisa Rueckel, SLP
• David Rueda, APRN
• Brooke Diane Ruehl, M.S.
• Jennifer Jaime Ruel

• Gerontology Occupational Therapist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Gerontology Occupational Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.