Individual
DORIAN BETH BANNISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L CLT
Contact information
Practice address
2031 POTTERY AVE, PORT ORCHARD, WA 98366-2010
(360) 876-8035
Mailing address
650 RIVER RD, WINDHAM, ME 04062-4607
(207) 671-5433
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
004413
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004413
OT LICENSE
GA
01
—
OT1822
OT LICENSE
ME
01
—
OT600002876
LICENSE
WA
Enumeration date
09/26/2006
Last updated
04/28/2011
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