Basic Information
| Provider Information | |||||||||
| NPI: | 1669751228 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DORNHELM | ||||||||
| FirstName: | MAIDELLE | ||||||||
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| Credential: | OT/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 WOODROW RD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103121313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183560008 | ||||||||
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| Practice Location | |||||||||
| Address1: | 80 WOODROW RD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103121313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183560008 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2011 | ||||||||
| LastUpdateDate: | 08/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 013614-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.