Healthcare Provider Details

I. General information

NPI: 1861543258
Provider Name (Legal Business Name): MS. DOROTHY MAE CARSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 26TH AVE E
BRADENTON FL
34208-7753
US

IV. Provider business mailing address

1523 22ND ST W
BRADENTON FL
34205-4761
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4600
  • Fax: 941-782-4601
Mailing address:
  • Phone: 941-747-0354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: