Provider Demographics
NPI:1366868515
Name:DELL, ANDREA (MSOTRL)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:DELL
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 STARR RD
Mailing Address - Street 2:APT 224
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2257
Mailing Address - Country:US
Mailing Address - Phone:810-705-0912
Mailing Address - Fax:
Practice Address - Street 1:7400 BAY RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CENTER
Practice Address - State:MI
Practice Address - Zip Code:48710-0001
Practice Address - Country:US
Practice Address - Phone:810-705-0912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008731225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist