Provider Demographics
NPI:1922473040
Name:DOBYNS, DERYLIN ZOE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DERYLIN
Middle Name:ZOE
Last Name:DOBYNS
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 1:5639 S LAKE RDG
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7122
Mailing Address - Country:US
Mailing Address - Phone:417-889-1130
Mailing Address - Fax:
Practice Address - Street 1:5639 S LAKE RDG
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7122
Practice Address - Country:US
Practice Address - Phone:417-889-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist