Provider Demographics
NPI:1891093639
Name:DIXON, ANDRAE MARY (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ANDRAE
Middle Name:MARY
Last Name:DIXON
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:PO BOX 1708
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48347-1708
Mailing Address - Country:US
Mailing Address - Phone:248-922-9200
Mailing Address - Fax:248-922-9700
Practice Address - Street 1:7508 M E CAD BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4281
Practice Address - Country:US
Practice Address - Phone:248-922-9200
Practice Address - Fax:248-922-9700
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist