Healthcare Provider Details

I. General information

NPI: 1538369723
Provider Name (Legal Business Name): WHD CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S 6TH ST
KLAMATH FALLS OR
97601-6114
US

IV. Provider business mailing address

PO BOX 1359
KLAMATH FALLS OR
97601-0075
US

V. Phone/Fax

Practice location:
  • Phone: 541-887-7362
  • Fax: 541-273-2486
Mailing address:
  • Phone: 541-882-1540
  • Fax: 541-882-2583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2063
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number242685
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12514
License Number StateOR

VIII. Authorized Official

Name: MRS. DENA LYNN DIXON
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: M.S., P.T.
Phone: 541-887-7362