Provider Demographics
NPI:1144623075
Name:DORADO, VANESSA (MS, OTR/L, SLP-A)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DORADO
Suffix:
Gender:F
Credentials:MS, OTR/L, SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15986 SW 109TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-3104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 LEXINGTON DR STE H
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6646
Practice Address - Country:US
Practice Address - Phone:601-910-7300
Practice Address - Fax:601-910-7071
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
FLOT16644225X00000X
MSOT3605225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician