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General NPI Number Information
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NPI Number | 1730451022
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Entity Type | Organization
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Legal Business Name | ROBERT E DORER M O T R L C H T INC
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 08/07/2012
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Provider Practice Location Address
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Address Line | 1624 W OLIVE AVE SUITE G
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City | BURBANK
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State | CA
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Zip | 91506-2459
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Country | US
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Telephone | 818-841-1965
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Fax | 818-841-1969
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Provider Business Mailing Address
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Address Line | 1624 W OLIVE AVE SUITE G
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City | BURBANK
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State | CA
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Zip | 91506-2459
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Country | US
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Telephone | 818-841-1965
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Fax | 818-841-1969
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. ROBERT EDWIN DORER JR.
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Credential | M.O.T.R./L., C.H.T.
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Telephone | 818-841-1965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | OT1512
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License Number State | CA
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