Healthcare Provider Details

I. General information

NPI: 1861558355
Provider Name (Legal Business Name): MICHELLE LYNN DORFMAN MSOTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 17TH AVE
VERO BEACH FL
32960-3641
US

IV. Provider business mailing address

2975 PIEDMONT PL SW
VERO BEACH FL
32968-5091
US

V. Phone/Fax

Practice location:
  • Phone: 772-562-6877
  • Fax: 772-562-3153
Mailing address:
  • Phone: 772-564-6141
  • Fax: 772-564-6141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number10948
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: