MEDICARE: MRS. SUSAN MARIE DORSEY OTRL

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	225X00000X	Occupational Therapist	OT00001982	WA

General Provider Information

NPI Number	:	1407054372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN MARIE DORSEY OTRL

Provider Business Mailing Address
First Line	:	9833 WINDWARD DR NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-9734
Country	:	US
Telephone Number	:	360-867-1183
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 CAPITOL MALL DR SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-8657
Country	:	US
Telephone Number	:	360-357-7677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	07/08/2007

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