Provider Demographics
NPI:1548412547
Name:FURLONG, DORA DELAINE-WINTER (LMT, NCTMB)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:DELAINE-WINTER
Last Name:FURLONG
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E REMINGTON TER
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8538
Mailing Address - Country:US
Mailing Address - Phone:816-322-3055
Mailing Address - Fax:
Practice Address - Street 1:401 GALAXIE AVE
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-2078
Practice Address - Country:US
Practice Address - Phone:816-884-3039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007009415225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist