Provider Demographics
NPI:1467781807
Name:DORRIS, PATRICIA LYNN (LAC, MAC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:DORRIS
Suffix:
Gender:F
Credentials:LAC, MAC
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 878
Mailing Address - Street 2:
Mailing Address - City:WEST DOVER
Mailing Address - State:VT
Mailing Address - Zip Code:05356
Mailing Address - Country:US
Mailing Address - Phone:617-223-1246
Mailing Address - Fax:
Practice Address - Street 1:167 MAIN ST
Practice Address - Street 2:SUITE 312
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7128
Practice Address - Country:US
Practice Address - Phone:617-223-1246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091.0058195171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist