Provider Demographics
NPI:1588036354
Name:ANDERSON, TRISHIA (OT)
Entity Type:Individual
Prefix:
First Name:TRISHIA
Middle Name:
Last Name:ANDERSON
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 1:717 PRAIRIE BLVD
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5408
Mailing Address - Country:US
Mailing Address - Phone:701-880-0413
Mailing Address - Fax:
Practice Address - Street 1:717 PRAIRIE BLVD
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5408
Practice Address - Country:US
Practice Address - Phone:701-880-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01640225X00000X
SD0811225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist