Provider Demographics
NPI:1134668106
Name:STEVENS, DOROTHY
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:BUTTE FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97522-0133
Mailing Address - Country:US
Mailing Address - Phone:541-865-7890
Mailing Address - Fax:
Practice Address - Street 1:449 FEE ST
Practice Address - Street 2:
Practice Address - City:BUTTE FALLS
Practice Address - State:OR
Practice Address - Zip Code:97522-0059
Practice Address - Country:US
Practice Address - Phone:541-865-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22725225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist