Provider Demographics
NPI:1730163940
Name:PELANEK, DOROTHY MARIE (OTR CHT)
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:MARIE
Last Name:PELANEK
Suffix:
Gender:F
Credentials:OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-0384
Mailing Address - Country:US
Mailing Address - Phone:304-487-1661
Mailing Address - Fax:304-487-1848
Practice Address - Street 1:416 OLD BLUEFIELD RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-0384
Practice Address - Country:US
Practice Address - Phone:304-487-1661
Practice Address - Fax:304-487-1848
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV622225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9440049000Medicaid
HA 4013051Medicare ID - Type Unspecified