Provider Demographics
NPI:1548219744
Name:DILLINGER, MANDY LEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:LEE
Last Name:DILLINGER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11222 WHISPER FALLS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3538
Mailing Address - Country:US
Mailing Address - Phone:210-592-7635
Mailing Address - Fax:
Practice Address - Street 1:11222 WHISPER FALLS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3538
Practice Address - Country:US
Practice Address - Phone:210-592-7635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112617225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112617OtherOT LICENSE