MEDICARE: ROSALYN ANN DORIS

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1568607125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALYN ANN DORIS

Provider Business Mailing Address
First Line	:	6277 HARCROSS CT
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-5613
Country	:	US
Telephone Number	:	352-556-4576
Fax Number	:	352-556-4636

Provider Business Practice Location Address
First Line	:	6277 HARCROSS CT
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-5613
Country	:	US
Telephone Number	:	352-556-4576
Fax Number	:	352-556-4636

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

Provider Enumeration Date	:	12/11/2008
Last Update Date	:	12/11/2008

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