Provider Demographics
NPI:1053319764
Name:DEHART, DOROTHY ELIZABETH (MOTR/L)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:ELIZABETH
Last Name:DEHART
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 S ATLANTIC ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-2726
Mailing Address - Country:US
Mailing Address - Phone:406-683-4453
Mailing Address - Fax:406-683-4453
Practice Address - Street 1:30 MT HIGHWAY 91 S
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3535
Practice Address - Country:US
Practice Address - Phone:406-683-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT524225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT340323Medicaid