Provider Demographics
NPI:1609403534
Name:PORTER, DOROTHY JEAN
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JEAN
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 SPRING MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-7660
Mailing Address - Country:US
Mailing Address - Phone:850-321-8923
Mailing Address - Fax:
Practice Address - Street 1:281 SPRING MEADOWS RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-7660
Practice Address - Country:US
Practice Address - Phone:850-321-8923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services