Provider Demographics
NPI:1770397762
Name:DORVIL, JORDAN EDOUARD (OTR/L)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:EDOUARD
Last Name:DORVIL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:MARIE
Other - Last Name:EDOUARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:67 S BEDFORD ST STE 101W
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-5152
Mailing Address - Country:US
Mailing Address - Phone:617-865-9445
Mailing Address - Fax:
Practice Address - Street 1:67 S BEDFORD ST STE 101W
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-5152
Practice Address - Country:US
Practice Address - Phone:617-865-9445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15105225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics