MEDICARE: HEATHER L. DORRANCE

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	225XP0200X	Pediatric Occupational Therapist	3247	SC

General Provider Information

NPI Number	:	1881727774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER L. DORRANCE

Provider Business Mailing Address
First Line	:	4324 LOUISIANA AVE
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-7597
Country	:	US
Telephone Number	:	662-434-8544
Fax Number	:

Provider Business Practice Location Address
First Line	:	4324 LOUISIANA AVE
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-7597
Country	:	US
Telephone Number	:	662-434-8544
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/12/2010

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Directions to “ HEATHER L. DORRANCE ” Practice Location

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