Provider Demographics
NPI:1962947093
Name:PENNY DOREY
Entity type:Organization
Organization Name:PENNY DOREY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-880-5391
Mailing Address - Street 1:31010 SW NEHALEM CT
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9736
Mailing Address - Country:US
Mailing Address - Phone:503-880-5391
Mailing Address - Fax:
Practice Address - Street 1:31010 SW NEHALEM CT
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9736
Practice Address - Country:US
Practice Address - Phone:503-880-5391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR02642251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health