Provider Demographics
NPI:1821580317
Name:DORLAND, ANNE MARIE (OTRL)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:DORLAND
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 RUTH DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-8806
Mailing Address - Country:US
Mailing Address - Phone:810-429-7695
Mailing Address - Fax:
Practice Address - Street 1:512 BEACH ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3122
Practice Address - Country:US
Practice Address - Phone:810-629-4117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201010049225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist