Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 107410 | TX |
NPI | 1003149071 |
---|---|
Provider Name | Loretta Dorsey |
First Address | Fort Worth, TX 76137-5481 |
Second Address | Irving, TX 75038-6551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2009 |
Last Update Date | 09/09/2009 |