Healthcare Provider Details

I. General information

NPI: 1518185479
Provider Name (Legal Business Name): DORTLIES HELENE RELEFORD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 MARSHALL RD
GREENWOOD SC
29646-4216
US

IV. Provider business mailing address

139 COOKS BRIDGE RD
FOUNTAIN INN SC
29644-5801
US

V. Phone/Fax

Practice location:
  • Phone: 864-227-7250
  • Fax: 864-227-7272
Mailing address:
  • Phone: 864-409-1302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number2110
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: