Provider Demographics
NPI:1104997535
Name:ESTEP, DOLORES JEANNE (OT L CHT)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:JEANNE
Last Name:ESTEP
Suffix:
Gender:F
Credentials:OT L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503
Mailing Address - Country:US
Mailing Address - Phone:937-390-7840
Mailing Address - Fax:937-390-8935
Practice Address - Street 1:1204 VILLA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503
Practice Address - Country:US
Practice Address - Phone:937-390-7840
Practice Address - Fax:937-390-8935
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000670225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2900696Medicaid
OH2900696Medicaid
OH0909320001Medicare NSC