Provider Demographics
NPI:1063818177
Name:SINGLETON, ANDRE LORENZO (COTA)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:LORENZO
Last Name:SINGLETON
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6648
Mailing Address - Country:US
Mailing Address - Phone:253-363-1985
Mailing Address - Fax:
Practice Address - Street 1:105 BIRCH ST
Practice Address - Street 2:
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6648
Practice Address - Country:US
Practice Address - Phone:253-363-1985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC 60488135224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant