Provider Demographics
NPI:1033173216
Name:FORD, DORIAN (OTRL,CHT)
Entity Type:Individual
Prefix:MRS
First Name:DORIAN
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:OTRL,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 SW 160TH ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3003
Mailing Address - Country:US
Mailing Address - Phone:206-244-4263
Mailing Address - Fax:206-244-8703
Practice Address - Street 1:275 SW 160TH ST
Practice Address - Street 2:STE. 201
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3003
Practice Address - Country:US
Practice Address - Phone:206-244-4263
Practice Address - Fax:206-244-8703
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225XH1200X
WAOT00000412225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8339830Medicaid
WA8931805OtherCRIME VICTUMS
WA0031572OtherDEPT. OF LABOR&INDURSTIES
WAA004OtherTRICARE
WAFO4753OtherREGENCE