MEDICARE: THERESA MICHELLE DORSEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1447856885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA MICHELLE DORSEY

Provider Business Mailing Address
First Line	:	3505 GOLDEN HILL DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-2885
Country	:	US
Telephone Number	:	202-590-8268
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 IRVINGTON ST SW APT 203
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-1059
Country	:	US
Telephone Number	:	202-834-4288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2020
Last Update Date	:	12/10/2020

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