MEDICARE: DOLORES JEANE ESTEP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	OT 000670	OH

General Provider Information

NPI Number	:	1386838688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOLORES JEANE ESTEP

Provider Business Mailing Address
First Line	:	1204 VILLA RD
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-1407
Country	:	US
Telephone Number	:	937-390-7840
Fax Number	:	937-390-8935

Provider Business Practice Location Address
First Line	:	1204 VILLA RD
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45503-1407
Country	:	US
Telephone Number	:	937-390-7840
Fax Number	:	937-390-8935

Authorized Official
Title or Position	:	SECRETARY
Name	:	MRS. KELLY J KITCHEN
Credential	:
Telephone Number	:	937-390-7840

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	10/05/2011

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