Basic Information
Provider Information
NPI: 1184889370
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOSS
FirstName: WILLIAM
MiddleName: DAVID
NamePrefix:  
NameSuffix:  
Credential: OTR/L
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3585 BRAMBLETON AVE
Address2: REHAB DEPT
City: ROANOKE
State: VA
PostalCode: 240186521
CountryCode: US
TelephoneNumber: 5407761029
FaxNumber: 5407761038
Practice Location
Address1: 3585 BRAMBLETON AVE
Address2: REHAB DEPT
City: ROANOKE
State: VA
PostalCode: 240186521
CountryCode: US
TelephoneNumber: 5407761029
FaxNumber: 5407761038
Other Information
ProviderEnumerationDate: 07/28/2008
LastUpdateDate: 07/28/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X0119004440VAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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