Provider Demographics
NPI:1558142828
Name:ANDALUZ, DAWN (OTR/L)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:ANDALUZ
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 1:4778 LAGO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4930
Mailing Address - Country:US
Mailing Address - Phone:954-647-4022
Mailing Address - Fax:
Practice Address - Street 1:4125 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4456
Practice Address - Country:US
Practice Address - Phone:954-968-8333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10349225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist