Provider Demographics
NPI:1184106239
Name:ANDERSON, HALLIE DEW (OTR/L)
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:DEW
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:DEW
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2017 W WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5913
Mailing Address - Country:US
Mailing Address - Phone:417-889-4800
Mailing Address - Fax:
Practice Address - Street 1:2017 W WOODLAND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5913
Practice Address - Country:US
Practice Address - Phone:417-889-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001576225XP0019X
MO2018032487225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation