Provider Demographics
NPI:1417058710
Name:BANNISTER, DORIAN BETH (OTR/L CLT)
Entity Type:Individual
Prefix:
First Name:DORIAN
Middle Name:BETH
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:OTR/L CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4607
Mailing Address - Country:US
Mailing Address - Phone:207-671-5433
Mailing Address - Fax:
Practice Address - Street 1:2031 POTTERY AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2010
Practice Address - Country:US
Practice Address - Phone:360-876-8035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004413225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEOT1822OtherOT LICENSE
GA004413OtherOT LICENSE
WAOT600002876OtherLICENSE
MEOT1822OtherOT LICENSE