Provider Demographics
NPI:1578517157
Name:DELLASANDRO, CLEO M (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CLEO
Middle Name:M
Last Name:DELLASANDRO
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 1:197 COUNTY ROAD 102
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:MS
Mailing Address - Zip Code:38951-9769
Mailing Address - Country:US
Mailing Address - Phone:662-412-2550
Mailing Address - Fax:800-613-2982
Practice Address - Street 1:197 COUNTY ROAD 102
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:MS
Practice Address - Zip Code:38951-9769
Practice Address - Country:US
Practice Address - Phone:662-412-2550
Practice Address - Fax:800-613-2982
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT1953225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist