Mr. Dennis Wayne Dillard
Orthotic Fitter
741 W Main St
Peoria
, Illinois 61606-2017
Mr. Dennis Wayne Dillard
Orthotic Fitter
741 W Main St
Peoria
, Illinois 61606-2017
(309) 565-7133
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About
Features
Specialties
- Orthotic Fitter
Languages spoken
- English
Location
First Address
- Mr. Dennis Wayne Dillard
- 10823 W Smithville Rd
- Hanna City, IL
- Zip : 61536-9711
- Phone : (309) 565-7133
Second Address
- Mr. Dennis Wayne Dillard
- 741 W Main St
- Peoria, IL
- Zip : 61606-2017
- Phone : (309) 676-2276
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 225000000X | Orthotic Fitter | 212-000127 | IL |
National Provider Identifier
| NPI | 1275667115 |
|---|---|
| Provider Name | Mr. Dennis Wayne Dillard |
| First Address | Hanna City, IL 61536-9711 |
| Second Address | Peoria, IL 61606-2017 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 15/03/2007 |
| Last Update Date | 09/11/2012 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 212-000127 | STATE LICENSED PEDORTHIST (01) | IL |
| CPED1563 | AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS, AND PEDORTHICS, INC. (01) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.