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NPI Code Detail

MEDICARE: DORIAN BETH BANNISTER OTR/L CLT

MEDICARE: DORIAN BETH BANNISTER OTR/L CLT
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
1225X00000XOccupational Therapist004413GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OT1822OTHERMEOT LICENSE
2004413OTHERGAOT LICENSE
3OT600002876OTHERWALICENSE

General Provider Information

NPI Number : 1417058710
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORIAN BETH BANNISTER OTR/L CLT
Provider Business Mailing Address
First Line : 650 RIVER RD
Second Line :
City : WINDHAM
State : ME
Zip : 04062-4607
Country : US
Telephone Number : 207-671-5433
Fax Number :
Provider Business Practice Location Address
First Line : 2031 POTTERY AVE
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98366-2010
Country : US
Telephone Number : 360-876-8035
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 04/28/2011

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