Provider Demographics
NPI:1356304174
Name:TELLIER, ANDREA CHRISTINE (OT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:CHRISTINE
Last Name:TELLIER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3166 BUCKHAVEN DR SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9383
Mailing Address - Country:US
Mailing Address - Phone:616-813-9237
Mailing Address - Fax:
Practice Address - Street 1:3166 BUCKHAVEN DR SE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9383
Practice Address - Country:US
Practice Address - Phone:616-813-9237
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000589225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist