Healthcare Provider Details

I. General information

NPI: 1013056118
Provider Name (Legal Business Name): DORA M HUTCHENS O.T.R.,L.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 ROSEWOOD CIR
ELIZABETHTON TN
37643-6628
US

IV. Provider business mailing address

143 ROSEWOOD CIR
ELIZABETHTON TN
37643-6628
US

V. Phone/Fax

Practice location:
  • Phone: 423-895-1046
  • Fax: 423-547-3093
Mailing address:
  • Phone: 423-895-1046
  • Fax: 423-547-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT0000001288
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: