Provider Demographics
NPI:1386838688
Name:DOLORES JEANE ESTEP
Entity Type:Organization
Organization Name:DOLORES JEANE ESTEP
Other - Org Name:SPRINGFIELD HAND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KITCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-390-7840
Mailing Address - Street 1:1204 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1407
Mailing Address - Country:US
Mailing Address - Phone:937-390-7840
Mailing Address - Fax:937-390-8935
Practice Address - Street 1:1204 VILLA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-1407
Practice Address - Country:US
Practice Address - Phone:937-390-7840
Practice Address - Fax:937-390-8935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT 000670171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP9267471Medicare PIN
OH0909320001Medicare NSC