Provider Demographics
NPI:1538296926
Name:ORME, DOREEN MAY (PT)
Entity type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:MAY
Last Name:ORME
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 CLOVER DR
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-9474
Mailing Address - Country:US
Mailing Address - Phone:707-459-6772
Mailing Address - Fax:707-459-6700
Practice Address - Street 1:1253 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-4210
Practice Address - Country:US
Practice Address - Phone:707-459-6772
Practice Address - Fax:707-459-6700
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10139225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0101390Medicaid
CAPT0101390Medicaid