Healthcare Provider Details

I. General information

NPI: 1871817007
Provider Name (Legal Business Name): DORENE E HANES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 HIGH ST
WORTHINGTON OH
43085-4109
US

IV. Provider business mailing address

425 HAYMORE AVE N
WORTHINGTON OH
43085-2444
US

V. Phone/Fax

Practice location:
  • Phone: 614-847-1100
  • Fax:
Mailing address:
  • Phone: 614-431-6933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number33.006841
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: