Provider Demographics
NPI:1063582328
Name:ORELLANA, DORYS MERCEDES (OTR)
Entity type:Individual
Prefix:
First Name:DORYS
Middle Name:MERCEDES
Last Name:ORELLANA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18617 NW 84TH PSGE APT 2205
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2594
Mailing Address - Country:US
Mailing Address - Phone:786-234-3257
Mailing Address - Fax:305-512-4404
Practice Address - Street 1:18617 NW 84TH PSGE APT 2205
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2594
Practice Address - Country:US
Practice Address - Phone:786-234-3257
Practice Address - Fax:305-512-4404
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8184225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0883AMedicare ID - Type UnspecifiedTHERAPY SERVICES