Provider Demographics
NPI:1508078908
Name:PURTELL, DOROTHY SABINE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:SABINE
Last Name:PURTELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 WILLIAMSON ST UNIT 406
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-4085
Mailing Address - Country:US
Mailing Address - Phone:608-347-0574
Mailing Address - Fax:
Practice Address - Street 1:808 WILLIAMSON ST UNIT 406
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4085
Practice Address - Country:US
Practice Address - Phone:608-347-0574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3874-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40459800Medicaid