Provider Demographics
NPI:1891226460
Name:ANDERSON, DIRK (OTR/L)
Entity Type:Individual
Prefix:
First Name:DIRK
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
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 1:15300 WEST AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4687
Mailing Address - Country:US
Mailing Address - Phone:708-349-3388
Mailing Address - Fax:708-349-3334
Practice Address - Street 1:11947 S HARLEM AVE STE 100
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1482
Practice Address - Country:US
Practice Address - Phone:708-361-7929
Practice Address - Fax:708-361-6310
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.011899225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist