Provider Demographics
NPI:1013191428
Name:ANDRE, SUSAN E (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:E
Last Name:ANDRE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2419 HIGHWAY 121
Mailing Address - Street 2:TEXAS ORTHOPEDIC SPECIALISTS, PLLC
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021
Mailing Address - Country:US
Mailing Address - Phone:817-540-4477
Mailing Address - Fax:817-540-5633
Practice Address - Street 1:2419 HIGHWAY 121
Practice Address - Street 2:TEXAS ORTHOPEDIC SPECIALISTS
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021
Practice Address - Country:US
Practice Address - Phone:817-540-4477
Practice Address - Fax:817-540-5633
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105821225X00000X
225XH1200X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB115376OtherMEDICARE PTAN