Provider Demographics
NPI:1043340656
Name:FISHBONE, DORI (MS OTRL)
Entity Type:Individual
Prefix:
First Name:DORI
Middle Name:
Last Name:FISHBONE
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RUSSELL ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-8545
Mailing Address - Country:US
Mailing Address - Phone:781-373-1547
Mailing Address - Fax:
Practice Address - Street 1:124 WATERTOWN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2576
Practice Address - Country:US
Practice Address - Phone:617-923-4410
Practice Address - Fax:617-923-0468
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8218225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics