Healthcare Provider Details

I. General information

NPI: 1144623075
Provider Name (Legal Business Name): VANESSA DORADO M.S., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1493 NORTHLAKE DR
JACKSON MS
39211-2138
US

IV. Provider business mailing address

PO BOX 59083
JACKSON MS
39284-9083
US

V. Phone/Fax

Practice location:
  • Phone: 305-244-1531
  • Fax: 601-402-9793
Mailing address:
  • Phone: 305-244-1531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT16644
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT3605
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: