Provider Demographics
NPI:1518185479
Name:RELEFORD, DORTLIES HELENE (PTA)
Entity Type:Individual
Prefix:
First Name:DORTLIES
Middle Name:HELENE
Last Name:RELEFORD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 COOKS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-5801
Mailing Address - Country:US
Mailing Address - Phone:864-409-1302
Mailing Address - Fax:
Practice Address - Street 1:1110 MARSHALL RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4216
Practice Address - Country:US
Practice Address - Phone:864-227-7250
Practice Address - Fax:864-227-7272
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2110225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner